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Online Application for the Dalhart Volunteer Fire Department

  1. Section 1: Personal Information
  2. Sex
  3. Marital Status
  4. Section 2: General Information
  5. Have you been a member of any other Fire Department?*
  6. When can you respond to a toned call (Click 1 or both) ?*
  7. Do you Live within City Limits of Dalhart or response time of 5 minutes or less?*
  8. Section 3: Employment Information
  9. Give a Complete account of your present and past employment
  10. Section 4: Medical Information
  11. Family Medical History*
  12. In the {ast 2 years, have you ever missed work due to an injury or sickness, including colds, flu, ect?*
  13. Do you have any injury, illness, defect, deformity or disease which may interfere with your ability to perform your job on the Department?
  14. Section 5: Certification

    I, the undersigned, applying for the membership with the Dalhart Volunteer Fire Department, do hereby certify that the answers to the above questions are true and correct. I understand that any false answers will be grounds for dismissal and I agree to hold the Department and/or the City of Dalhart blameless for such dismissal. I also agree to undergo a physical examination, giving the examining physician permission to contact my personal physician, and allowing the examining physician to submit his findings to the Department, the Pension Board and/or the City of Dalhart. Furthermore; I understand that this application is subject to approval by the Officers of the Department and Pension Board.

  15. By clicking "I agree," you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your "electronic signature" is valid and binding upon you to the same force and effect as a handwritten signature.

  16. Do you Agree?*
  17. Leave This Blank:

  18. This field is not part of the form submission.