Citizens Fire Academy Application Question Title * 1. First & Last Name: Question Title * 2. Home address: Question Title * 3. Email address: Question Title * 4. Phone: Question Title * 5. Date of birth: Question Title * 6. Driver's License number: Question Title * 7. What is your T-shirt size? Question Title * 8. Occupation or Profession: Question Title * 9. Employer: Question Title * 10. Have you ever been arrested for, convicted of or cited for an offense other than a traffic citation? Yes No Question Title * 11. If yes, please explain: Question Title * 12. How long have you been a Brazos Valley resident? Question Title * 13. What are your hobbies and special interests? Question Title * 14. Please let us know why you would like to attend Citizens Fire Academy: Question Title * 15. Can you commit to attending all of the classes? Yes No CSFD understands that unforeseen circumstances arise and you may have to miss one or two classes. However, please indicate your level of commitment to attending every class so that you may be adequately prepared for the live burn. Question Title * 16. How did you hear about Citizens Fire Academy? (e-mail, friend, social media, etc.) Question Title * 17. Please provide three references:Reference 1 Name: Phone number: Relationship: Question Title * 18. Reference 2 Name: Phone number: Relationship: Question Title * 19. Reference 3 Name: Phone number: Relationship: Question Title * 20. I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statements and answers to questions. I understand that any omissions or false statements on my application shall be sufficient cause for rejection for enrollment or dismissal from the College Station Fire Department Citizen’s Fire Academy.I further understand that the College Station Fire Department will conduct a background check that may include any criminal history. Agree Disagree Question Title * 21. I, for myself and my organization, school or group, release and agree to hold harmless for any and all purposes the City, its agents, officers, employees, volunteers and assigns from any and all liabilities, claims, demands, or injuries that may be sustained by me or my organization, school or group members in attendance as a result of or arising from me or my organization, school or group, participating or performing activities for or in the College Station Fire Department. Agree Disagree Question Title * 22. I, for myself and my organization, school or group, hereby accept and assume all risk and responsibility for any harm, injury, or damage, to myself or my property, while my organization, school or group and I are on City-owned property or any other property and while participating or performing activities for or in the College Station Fire Department. Agree Disagree Question Title * 23. I hereby give the City the right to photograph, televise, film, and sound record me and my organization, school or group acts, appearances and utterances of me and those from my organization, school or group and to use any descriptive words or names, including my name or my organization, school or group name in conjunction therewith and without limit as to the time, to produce and reproduce the same or any part thereof by any method and to use for any purpose which the City deems proper. All such photographs, teletapes, films and sound recording shall be the exclusive property of the City and I and my organization, school or group hereby relinquish all rights, title, and interest therein. Agree Disagree Submit Form
