Barnardsville Fire Department

BARNARDSVILLE FIRE DEPARTMENT

Application for Employment/Membership

This application may be returned to:

Barnardsville Fire Department or Barnardsville Fire Department

100 Dillingham Road mail PO Box 126

Barnardsville, NC 28709 to Barnardsville, NC 28709

Name______First ______Middle______Date of Application______

Social Security #______DOB______Email______

Position for which applying: Volunteer______Career______Part-Time______

Street Address______City______State____ Zip Code______

Mailing Address______City______State____ Zip Code______

Home Phone______Work Phone______

Are you a U.S. Citizen? Yes____ No____ If not, do you have a permit which allows you

to work in the U.S.? Yes____ No____ Do you smoke? Yes____ No____ Do you have a

valid N.C. driver’s license? Yes____ No ____ D.L. Number______

Do you have a valid N.C. Commercial driver’s license (CDL) Yes____ No____?

Have you ever been convicted as an adult for a traffic law violation? Yes____ No _____

If yes, please explain. ______

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Schools Attended- Name & Address (High School and Colleges)

______Date Completed_____ Major Study______Degree _____

______Date Completed_____ Major Study ______Degree _____

______Date Completed ____ Major Study ______Degree______

Describe any education or training you have had which is not covered above, such as vocational school, service schools or in-service training, which you feel may be relevant to the position you are applying for include any licenses or certifications you have which may be helpful or required by this position. Include the name of the course or training, the name of the institution, length of the course and the date completed.

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List any special skills or qualifications you have which may be helpful in this job.

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1. List your present employer.

Employer______Position/ Title______

Employer Address______

Dates of Employment______Employer Phone #______

Supervisor’s Name______Describe your work______

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2. List your past employer.

Past Employer______Position/Title______

Dates of Employment______Employer Phone #______

Supervisor’s Name______

Reason for leaving______

Describe your work______

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3. List any other Emergency Services Affiliations you may have been a member of and list their phone numbers and contact person.

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References:

Name______Relationship______Phone #______

Name ______Relationship ______Phone #______

Name ______Relationship______Phone #______

I hereby certify that all information in this application and attachments is true. I authorize the Barnardsville Volunteer Fire Department to obtain medical, education,employment and conviction records related to my job application and I understand that all information provided here is subject of verification. I agree as a condition of continued employment/membership, to authorize a criminal records check during the course of my employment/membership, if requested. I acknowledge that any falsification on this application is grounds for immediate disqualification.

I understand that I may be required to pass various job-related examinations in order to be considered for employment/membership and that I must complete a physical examination prior to my employment/membership. I also understand that I am required to serve a probationary period during which time my performance will be evaluated and I may be terminated if my conduct or performance is not fully satisfactory. I further understand that I am subject to termination for program revision or budgetary reasons at any time.

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Applicants Signature Date

OFFICE USE ONLY: MEMBERSHIP COMMITTEE

Interview Date______Accepted Date______

BARNARDSVILLE FIRE DEPARTMENT

*******PHYSICAL RECORD*******

Height______Weight______Blood Type______Race______Age______

DOB______Hair Color______Eye Color______Other

distinguishing features (scars, tattoos, etc.)______

Corrective lenses: ( ) Contacts( ) Glasses( ) NA

MEDICAL HISTORY-CHECK APPROPRIATE COLUMN

YESNOYESNO______

( ) ( ) Hypertension ( ) ( ) Hearing Difficulty ( ) ( ) Heart Disease ( ) ( ) Respiratory Problems

( ) ( ) Glaucoma( )( ) Mental Illness

( ) ( ) Inner Ear Problems( )( ) Alcohol/Drug Abuse

( ) ( ) Diabetes( )( ) Allergy Problems

( )( ) Epilepsy( )( ) Sight Limitations

( )( ) Other

If yes is checked in any of the above boxes, please explain. Describe control procedures______

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Have you seen a physician within the last year? ( ) Yes ( ) No.

WHOM TO CONTACT IN CASE OF AN EMERGENCY

Name______Phone # Day______Night______

Name______Phone # Day______Night______

Name______Phone # Day______Night______

BARNARDSVILLE FIRE DEPARTMENT

100 Dillingham Road

PO Box 126

Barnardsville, NC 28709

Emergency: 911 Fax: (828) 626-4444 Business: (828) 626-2222

DRUG TESTING POLICY

This policy has been developed by the Board of Directors for the Barnardsville Fire Department to insure the safety of life and property of the citizens in the Barnardsville fire district.

The Board of Directors grants the following rights to the Fire Chief:

1. To deny participation in any departmental activity by a member suspected of

being under the influence of alcohol or drugs.

2. To suspend any member suspected of drug or alcohol use, without having to justify

his/her actions.

3. To test any member suspected of using drugs or alcohol while engaged in volunteer

duties.

4. To require a random or specific test of any member.

5. To suspend any member who refuses to submit to an alcohol or drug testing.

6. To contract with a reputable laboratory in Buncombe County to perform alcohol and

drug tests.

7. Under no circumstances shall test results be made public.

I HAVE READ AND UNDERSTAND THE DRUG TESTING POLICY:

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Firefighter

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W. DuWaine Maney, Chairman Chief Kevin Mundy

Board of Directors Barnardsville Fire Department

BARNARDSVILLE VOLUNTEER FIRE DEPARTMENT

100 Dillingham Road

Barnardsville, North Carolina 28709

Fax: (828) 626-4444 Emergency: 911 Business: (828) 626-2222

MEMBERSHIP POLICY GUIDELINES

1. Request for membership

A.The applicant must be 18 years of age.

B.The applicant must be a resident of the Barnardsville Fire District

C. The applicant must complete an application to be a volunteer firefighter and provide conviction records (if any) from an accepted agency.

D.The membership committee will review the application and the Chief will notify the applicant of his or her acceptance or denial.

E.Upon acceptance, the membership committee will set the applicant up for an interview.

F.At this time, the applicant must sign the drug testing policy form. The applicant will also be given a medical requirements form that must be signed by a doctor after a physical (provided by the department). The applicant should start the series of three hepatitis B vaccinations (also provided by the department). If the applicant has proof of vaccination against hepatitis B, or refuses to get the vaccine, a form must be signed.

GThe applicant must attend a one-day orientation prior to going online as an active probationary firefighter.

H.New members will be accepted one time per year, with candidates going online January 1st each year.

I.After review of the above, and upon acceptance of the candidate by the membership committee, the candidate will begin a probationary period during which time he/she must obtain NFPA 1403 classes of fire service training before becoming an active member and must include blood borne pathogens (BBP) and 3 hours of HAZ-MAT training. This probation period is not to last over 11 months

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J.The candidate may not drive equipment on an emergency response, or be placed in hazardous situations (inside burning buildings, etc.) during the probationary period. There should be no non-emergency driving except with an officer or on-duty personnel.

K.If an experienced firefighter joins the department, any of the above requirements may be waived at the discretion of the officers, depending on the candidate’s training and experience.

1. Review of the candidate after their probation

1. The officers will discuss the merits of the candidate, including attitude, knowledge, willingness to follow instructions, and total fire department involvement.

1. The officers may deem necessary an additional probationary period of up to, but not exceeding, six months in order to ensure the candidate’s safety, knowledge, and training. At the end of the probationary period, upon recommendation by the officers, the candidate will be voted on by the fire department membership present, with majority rule.

1. At the end of the probationary period, the member will receive his or her badge and become an active firefighter.

1. Requirements to maintain active membership

1. The member must have 36 hours of annual fire service training, including 3 hours of BBP, 12 hours of certified instruction, and 3 hours of HAZ-MAT. If training requirements have not been met by December 31st of each year, the firefighter will be suspended of all duties and will have until January 31st to complete all needed training. At that time the Chief and the Training Officer will review the training records and reinstate all benefits. If the training requirements have not been met, all gear and radio equipment must be turned in immediately and the suspension period will continue until December 31stof that year. After this one-year suspension, he/she may reapply for membership.

B.The member must respond to 5% of the total calls per year.

C. The member must take an active role in fire department activities,

including fund- raisers.

D. The member must comply with all department bylaws and standard operational guidelines at all times.

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E.The member must take proper care of all fire department equipment and property.

F.The member must notify the Chief of any change in physical condition that might affect his or her ability to function or place him or her at a higher risk while involved in fire or EMS responses. At the discretion of the Chief, a doctor’s statement medical requirements form may be required to ensure adequate physical condition to perform required duties.

G.Any firefighter may be suspended for failure to carry out any or all of the above listed items, by recommendation of the Chief and Officers.

H.Any member who does not wish to be a firefighter but wishes to be affiliated with EMS must hold and maintain at least an EMT level certification. He/She must also obtain 36 hours of training each year. This must include at least 24 hours of medical CE, 3 hours of HAZ-MAT, and 3 hours of BBP each year. The member must also comply with all other membership policy guidelines except those regarding firefighter training.

1. The member must have a physical, a pulmonary breathing test, a TB test, and hepatitis B shots. The Safety Officer will keep these on record.

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W. DuWaine Maney, ChairmanKevin Mundy (Chief)

Board of DirectorsBarnardsville Fire Department

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Board MemberBoard Member

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Board MemberBoard Member

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Board MemberBoard Member

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Board MemberBoard Member

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Board MemberBoard Member