Junior Volunteer Application
McKenzie Fire & Rescue
McKenzie Fire & Rescue
Application for Volunteer Membership
or Student Program
Primary Phone Number
Alternate Phone Number
Please provide street address and mailing address (if different)
Are you over 18? If no, complete Junior Volunteer application.
Fire Service experience:
List any fire service experience.
First Aid experience:
List any First Aid experience.
Describe briefly why you want to be a Volunteer or Student:
If Interested in the Student Program, Are you currently enrolled anywhere?
Provide 3 references not related to or living with you. Please provide complete mailing address information.
I authorize McKenzie Fire & Rescue to investigate all references as well as personal background and DMV records. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.
IMPORTANT PLEASE READ! AUTHORIZATION for Personal Investigation and Release/Hold Harmless - Being not less than 18 years of age and realizing that performance of duty as a Volunteer Firefighter with McKenzie Fire & Rescue involves the protection of lives and property of the citizens of the lower McKenzie Valley and requires a person of the highest physical, moral, and mental qualifications, I hereby authorize complete investigation of my personal background and records by McKenzie Fire & Rescue, Lane County Sheriff’s Department and Oregon State Police, for the purpose of determining my qualifications as a potential firefighter with McKenzie Fire & Rescue. I also hereby release McKenzie Fire & Rescue, and all its employees and agents, and agree to hold harmless, defend and indemnify it from any and all claims or demands I, or others on my behalf or otherwise, might hereafter make which arise from said complete investigation of my personal background and record. This authorization for personal investigation and release/hold harmless herein is given in consideration of McKenzie Fire & Rescue processing and considering the Volunteer Firefighter Application of which this authorization and release/hold harmless is a part.
How Did You Hear About Us?
From a Friend or Volunteer
WePage or Facebook
Brochure From Local Business
Saw us on a Call
You may choose more than one.