Volunteer Applications In what capacity do you want to volunteer? (required) Firefighter Student Program Are you over 18 years old? If no, complete Junior Volunteer application. (required) Yes No Today's Date? Last name? (required) First Name? (required) Email? Primary Phone? Alternate Phone? Street Address Apt, Suite, Bldg. (optional) City State / Province / Region Postal / Zip Code Country Fire experience? (required) First Aid experience? (required) Describe briefly why you want to be a Volunteer or Student: (required) If Interested in the Student Program, are you currently enrolled anywhere? References: (required) 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. (required) Agree Disagree 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. (required) Agree Disagree How did you hear about us? Friend or Volunteer Webpage Social Media (Facebook, Twitter, Etc.) Brochure School visit Newspaper TV news Saw us on a call Verification (Please enter any two digits) (required) There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
