Established in 2005, Associate Members are a group of volunteers assisting Leander Fire Department in various ways. They provide rehabilitation services to the Firefighters and on-scene crew, including: hydration, rest schedules, accountability and assist EMS crews during emergencies and scheduled trainings. The Associates help organize and staff local community events including Academy graduations, Birthday Parties and the Firefighter for a Day program. They take any opportunity to talk with the public about what LFD does. Associates meet on a loose every other month schedule, but sometimes more while planning major events. Quarterly trainings are encouraged. Associates are a trusted part of this department who represent Leander Fire Department and the city and for that reason we have an application process for this unique volunteer position. For more information email Associate Lead, Gina Petty at r Community Outreach Coordinator, Carol Nelson Rabago at .

This is your chance to serve the community and become part of what makes Leander a safe and desirable city.

Contents of this Application:

Section 1: Personal Information

Section 2: Authorization to perform a Driving Record and Criminal Background Check

Section 3: Education and Civic Information

Section 4: Experience and Character References

Section 5: Acknowledgement

Section 1: Personal Information

Name:______Nickname or other alias in the last 5 years:______

Date of Birth:______Citizen of U.S.? YES/NOGender: Male/Female

Full Address:______

______

Have you lived out of the state of Texas in the past five years? YES/NO

If yes, please lists states or country:______

Have you been convicted of any offenses within the past 5 years? YES/NO

If yes, please explain (attach pages as needed):______

______

Primary Phone Number: (____)____-______circle one: home/cell/work

Secondary Phone Number: (____)____-______circle one: home/cell/work

Email Address:______

Driver’s License Number:______State:______Expiration:______

Social Security Number:______

Tell us how you learned about volunteer opportunities with Leander Fire Department:

______

______

______

______

Section 2: Authorization to perform a Driving Record and Criminal Background Check

I hereby authorize the Leander Fire Department to check and review my Driving Record and Criminal History. These records are private and confidential and will be handled in accordance with the City of Leander Records Management Policy. I understand that this record check will be part of my permanent record with the Leander Fire Department. The record will be reviewed as part of my affiliation (volunteer or employment) with the Leander Fire Department.

I understand that as a member of the Leander Fire Department, my Driving Record and Criminal History may be reviewed on a regular basis.

I understand while this is optional that failure to allow this check may lead to limited or prevention of my involvement or employment with the Leander Fire Department.

I ______Circle one: DO/DO NOT authorize the check of my Driving Record and Criminal History.

Signature:______Date: ______

Section 3: Education and Civic Information

Education:

Please mark all degrees or certificates obtained:

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  • High School Diploma/GED
  • Some College
  • Fire Academy (ACC, Oakhill, etc)
  • Technical Degree
  • Associate’s Degree
  • Bachelor’s Degree or Higher
  • Other:______

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Please describe any other training, specialized education, skills or abilities that enhance your application:______

______

______

Civic:

Please describe civic or community service activities you participate in:______

______

Please describe any awards, honors, or distinctions you have received:______

______

Section 4: Experience and Character References

Employment or Volunteer Experience:

Current or most recent employer:______

Dates employed from/to:______

Position/Title/Rank:______

Job Responsibilities:______

Previous employer:______

Dates employed from/to:______

Position/Title/Rank:______

Job Responsibilities:______

Previous employer:______

Dates employed from/to:______

Position/Title/Rank:______

Job Responsibilities:______

Character References:

Name:______Phone:______E-mail:______

Relationship:______Length of time known:______

Name:______Phone:______E-mail:______

Relationship:______Length of time known:______

Section 5: Acknowledgement

Read the following statement carefully and indicate your understanding and ACCEPTANCE by signing and dating below.

  1. I certify that all information provided by me in connection with my application whether on this document or not, is true and complete, and I understand that any misstatement, falsification, and/or omission of information shall be grounds for dismissal from the department.
  1. I authorize any persons or organizations referenced in this application to give you any and all information personal and/or otherwise, with regards to an of the subjects covered by this application, and I release all parties from liability from damages which may result from furnishing such information to you.
  1. I have read and understand the physical requirements of an Associate Volunteer. I can physically meet the requirements of the position. I understand that if I have a pre-existing medical condition, illness, or injury, that it is recommended by the Leander Volunteer Fire Department, Inc., Leander Fire Department, and the City of Leander that I receive approval to participate in the fire department activities from my personal physician.
  1. I understand that, if accepted, I am responsible from the cost of my uniform boots and pants. I will be provided with an Associate T-shirt and other items as needed.
  1. I understand that within 90 days of acceptance I need to have completed online trainings from FEMA.
  • IS-100b Introduction to Incident Command System
  • IS-200b ICS for Single Resources and Initial Action
  • IS-700a National Incident Management System NIMS
  • IS-800b National Response Plan NRP

Signature:______Date:______

I have interest in the following activities with Associates at this time:

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  • Birthday Party Host
  • Outreach at Community Events
  • Festival Planning and Working
  • Rehab in Training or Emergencies
  • Firefighter for a Day
  • CPR Instructor
  • 10 Minute CPR at events
  • Recruitment Activities

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