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2. Date*
   Date
4. Name*
5. Email Address*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Fax Number
16. What is your occupation?*
    If you are a student, please indicate your school and current grade level.
17. Current employer?
18. Are you less than 18 years old?*

    1. Yes
    2. No
20. Do you have any fire service certifications or experience?
    Please list your current or past firefighting certifications and any relevant experience.
22. Essay*
    Please explain your interest in the Milton Fire Department. If you are new to emergency services, explain what drew you to this opportunity. Also, please explain an previous volunteer or employment experience that might contribute to our squad's strength and diversity.
24. References*
    Please provide the name, occupation, and contact information (phone and/or email) for at least two professional references. Family members may not serve as references.
26. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
28. Electronic Signature
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field