Dekalb County, TN Fire Department
Online Application for Membership
Name (Last, First, Middle Initial):	Mailing Address:
Last Four Digits Of SSN:	Date of Birth (mm/dd/yyyy):
Place of Birth (city & state):	Email:
Have you ever been convicted of, or forfeited collateral for any firearms or explosive violation? Yes No	Are you now under any charges for any violation of law? Yes No
During the last 10 years have you forfeited collateral, been convicted, been imprisoned, been on probation, or been on parole? Yes No	Have you ever been convicted by a military court-martial? Yes No
Do you understand that you are considered an “employee” of county government and applicable alcohol/drug screening procedures apply: Yes No	Have you had any previous firefighting experience? (If yes, provide location, dates and duties in comments section below) Yes No
Do you have any disabilities that would prevent you from performing the essential functions of firefighting? Yes No	Which station of the DeKalb County Fire Department is the closest (by road) to your residence?
Are you a member of any other emergency organization (rescue squad, other county or municipal fire department)? (If yes, please provide name of agency/organization in comments below) Yes No	Please provide your Tennessee Driver’s License Number:
Phone Number:	What time of day is best to contact you?
Comments: