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Randle Fire & EMS

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Application For Membership

All applicants must pass a background investigation, there is no cost to the applicant for this process. Additional information will be collected in person to accomplish this prior to membership.
Member must attend weekly training/drills held Tuesday nights 18:30 at Station 1.

Position

Where did you hear about this opportunity?

First name

Birthday

Middle name

Cell Phone

Last name

Phone/Alternate

Email

Home Address:

Street Address

City

Region/State/Province

Postal / Zip code

Mailing Address:

My mailing address is the same as my home address.

Street Address

City

Region/State/Province

Postal / Zip code

Do you require any accommodations?

Accommodations:

Previous Fire or EMS Experience:

None/Entry Level

Firefighter

Emergency Medical Services

Support Services

Previous Experience:

Previous EMS Qualificatons:

None

CPR/First Aid

EMR

EMT/B

EMT/IV Tech

EMT/A

EMT/P

EMT Evaluator

Previous EMS Qualifications:

Previous Responder Experience:

None

IFSAC/ProBoard

ICS Certifications

Wildland Certifications

Other Certification

Previous Responder Experience:

Personal Reference:

Emergency Contact:

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relation

Street Address

Region/State/Province

Postal / Zip code

City

Additional Information or Comments:

By checking this box I hereby certify that the above answers are true and that I am in good health, to the best of my knowledge and belief, and that I will follow the rules, policies, and procedures of Randle Fire & EMS, Lewis County Fire Protection District #14. I further understand that falsification of this application may result in application denial or termination of membership.

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HEADQUARTERS

Station 14-1

9978 US Hwy 12

Randle, WA 98377

(360) 497-7745

©2024 Randle Fire & EMS

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