Volunteer Interest Form

Are you currently a licensed EMT/Firefighter?

Have you ever applied to this Fire District before?

AGREEMENT OF APPLICATION CERTIFICATION, AUTHORIZATIONS AND UNDERSTANDING OF EMPLOYMENT RELATIONSHIP I hereby state that all of the information I have provided on this Application or any other document submitted in connection with my acceptance into the District, and in any interview, are true and correct. I have withheld nothing that would, if disclosed, affect this Application unfavorable. I understand that if I am accepted into the District and any information is later found false in any respect or if I have omitted material information, I may be dismissed. I understand that if selected into the District, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States. PHYSICAL/CONTROLLED SUBSTANCES SCREENINGPahranagat Valley Fire District strongly believes in its responsibility to provide a safe and healthful workplace for all its volunteers. I understand that at any time after I am admitted into volunteer service for the District, the District may require me to submit to a physical examination to the extent permitted by law. I consent to the disclosure of the results of the physical examinations and related tests to the District. You should understand that YOU MAY BE TESTED for the presence of controlled substances before you are admitted into service as a condition of being accepted into the District. If you have any questions regarding this policy, please contact the Board Secretary/Manager before agreeing to volunteer status with Pahranagat Valley Fire District. I understand an offer to join the volunteer service may be made contingent on passing a job-related physical examination. I agree to submit to a controlled substances screening and physical examination by the District’s designated medical practitioner. I have read, and understand, and agree to the above-referenced physical examination and drug testing policy.I have read and understand the Pahranagat Valley Fire District Drugs, Alcohol, and Medical Conditions Policy and agree to abide by the policy. I understand if I fail to abide by the District Drug and Alcohol Policy I will be terminated from service with the District. NOT AN OFFER OF EMPLOYMENT I understand as follows that this is a volunteer position. There is currently no compensation for service as an EMT, Firefighter, or any other emergency services position. This position is at-will and for a definite period and may be terminated by the District or by me at any time and for any reason whatsoever, with or without good cause. No implied, oral or written agreements contrary to this express language of this Agreement are valid unless they are in writing. No supervisor or representative of the District, other than the Board of Directors of the District, has any authority to make any agreements contrary to the foregoing. This Agreement is the entire Agreement between the District and the volunteer regarding the rights of the District or the volunteer to terminate service, and this Agreement takes the place of all prior agreements, representations, and understandings of the volunteer and the District. I hereby acknowledge that I have read and understood the above statements. DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENT AND CONFIRM YOU VOLUNTARY AGREEMENT. Note: This Application expires within forty-five (45) days of the signature date below unless the District begins the review process within that time.