MONROE COUNTY EMERGENCY SERVICES

Volunteer Application

Persons interested in becoming a volunteer must meet the following criteria:

a. Must be at least 18 years of age.

b. Not been convicted of a felony in any jurisdiction within ten years prior to

employment/appointment.

c. Have a good moral character as determined by investigation under procedure

approved by the Director.

d. Pass an extensive background check including drug testing, criminal history and

driving history.

e. Be in good physical condition as determined by a medical examination and

successfully pass the minimum physical agility requirements as established by MCES.

f. Possess a high school diploma or a general education development equivalency.

g. Complete the Georgia Basic Firefighter Training Course approved by theCouncil and verified by successful completion of the State Firefighter Certification Test.

h. Possess a valid Georgia Driver's License.

Complete the attached application and supply all supporting documents as shown. If mailing

application, please send to Monroe County Emergency Services, 693 Juliette Rd, Forsyth, GA 31029.

Monroe County Emergency Services Volunteer Application

Right to Reject Services/Termination

The county reserves the right to limit the use of volunteers, adjust the hours of any volunteer or to reject services as it, in its sole discretion, deems fit, in order to best achieve its public purpose and policy. No employment of any other contractual right is created by these policies. Participation in any volunteer position of the Department shall be open to any individual and no individual shall be discriminated against based upon race, color, religion, age, sex, national origin or physical, mental or sensory handicap or on the basis of any other characteristic protected by law. Grounds for rejecting services may include, but are not limited to: unsatisfactory background check, gross misconduct or insubordination, being under the influence 'of alcohol or drugs, theft or prope11y misuse of County equipment or materials, mistreatment of clients or co-workers, failure relating to the essential functions of the volunteer position.

Volunteers should demonstrate good moral character; the County reserves the right to terminate or reject any volunteer who refuses or neglects to confirm their personal conduct to the standards of good citizenship.

Criminal History Check Procedures

1. All volunteers must consent to a Criminal History Check prior to volunteering.

2. Only designated MCBOC Administrative Staff may run background checks.

3. If convictions are found on the Criminal History Check, the following will be grounds for ineligibility to volunteer:

a. Simple Battery, where the victim is a minor b. Simple Battery against a person over the age of 21 (Violation in the last 7 years) c. Aggravated Battery, where the victim is a minor d. Aggravated Battery against a person over the age of 21 (Violation in the last 7 years) e. Cruelty to Children f. Crimes involving Family Violence g. Any sexual offense h. Contributing to the delinquency of a minor (Violation in the last 7 years) i. Alcohol related violations (Violation in last 2 years or multiple violations in the last 7 years) j. Violation of any controlled substance act (Violation in last 7 years) k. Murder or Felony Murder l. Criminal attempts to commit any above-named offenses m. Any felony not listed above (Violation in the last 7 years) n. Any other crime that bears upon fitness to have responsibility for safety and well-being of children. o. Any of the above style pending convictions or any other criminal acts that may result in a

probational status for one year.

MCES Volunteer Application

4. Ineligible persons will be contacted by the Director or designated Administrative staff to inform them of their ineligibility status.

5. If a volunteer is charged with any of the above violations during the program, he/she is required to immediately notify the Director. Violations during the program will result in immediate dismissal of his/her volunteer status.

I, the undersigned, authorize this information to be obtained in writing. Any person, firm or organization providing information or records in accordance with this authorization is released from any and all claims of liability for compliance. Such information will be held in confidence in accordance with the organization's guidelines.

Print Name

Signature

Date

MONROE COUNTY EMERGENCY SERVICES - VOLUNTEER APPLICATION

We consider applicants for all position without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER Last Name First Name Middle Name Social Security Number Last 4

Address County City State Zip

Home Number Cell Number Work Number

Email Address Station/Community Date

Date of Birth Age Marital Status Driver’s License License Class

EMS Certification Type EMS Certification Number Other Applicable Certifications

Are you currently employed? Yes No On what date would you be available to start?

May we contact your present employer? Yes No

No Have you been convicted of a felony within the last 10 years? Yes If yes, please explain

Have you been arrested in the last 3 years? Yes No If yes, please explain

No

Are you on probation or parole? Yes No

Are you presently awaiting trial or involved in civil litigation? Yes

Emergency Contact Information Name Relationship

Address City State Cell Phone Home Phone

EDUCATION NAME OF SCHOOL ADDRESS COURSE OF STUDY YEARS COMPLETED

DIPLOMA/ DEGREE

HIGH SCHOOL

OTHER

Indicate any foreign languages you can speak, read and/or write

Describe any Firefighting/EMS/Rescue training, apprenticeship, skills, extra-curricular activities

Describe any training received in the United States military. Provide a copy of your D. D. 214

Employment History Current/Former Employer Address Phone Number

Job Title Supervisor Date From Date To

Work Performed Reason For Leaving

MONROE COUNTY GOVERNMENT (AUTHORIZATION TO RELEASE INFORMATION)

Last Name First Name Middle Name

Address County City State Zip

Last 4 of Social Security Number Date of Birth

Driver's License Number State of Issue Expiration Date

ALCOHOL AND CONTROLLED SUBSTANCE TESTING

DRIVING HISTORY

I hereby authorize the Monroe County Board of Commissioners or other authorized representative of Monroe County bearing this Release or a copy thereof, within twelve (12) months of its date, to obtain any information pertaining to my driving record. This release is executed with full knowledge and understanding that the information as described above, to third parties in the course of fulfilling its official responsibilities. Should here be any questions to the validity of this release, you may contact me as indicated above. I hereby authorize my current and former employers to provide Monroe County and its agents any and all information that they may request. I hereby release those employers from liability for providing such information.

Signature Date

As a condition of services by Monroe County Government, you will be required to submit to an alcohol and controlled substance screening test. Volunteers must, as a condition of services, abide by the policy regarding the effects of drug use and unlawful possession controlled substances. Volunteers must report any conviction under criminal drug statute for such violations. A report of the convicted must be made within five (5) days after the conviction. (This requirement is mandated by the Drug-Free Act of 1988.) In order to perform services by the Monroe County Government, you must successfully pass this screening test. By signing this form, you are acknowledging that you consent to such an examination and screening test.

Signature Date

Name-Based Criminal History Record Information Consent/Inquiry Form

I hereby authorize to conduct an inquiry for

the purpose(s) listed below and receive any Georgia and/or national criminal history record information as authorized by state and federal law.

First Name:

Address:

Sex: Race: Date of Birth: Last 4 of Social Security #:

This authorization is valid for days from date of signature.

I, , give consent to the above-named entity to perform periodic criminal history background checks for the duration of my employment.

Signature Date

Attorney for Individual (Pur E and U Only) Bar Number Date

Date of Inquiry: Time of Inquiry: Operator’s Initials:

Purpose Code Used: (check all that apply) E - Employment J - Civilian Criminal Justice Employment (State & III Info Received) M - Working with Mentally Disabled/Developmentally Disabled N - Working with Elderly P - Public Records U - Personal Copy W - Working with Children Z - Sworn Criminal Justice Employment (State & III Info Received) F – (Probate Court – Firearms Permit Application) Permit Number:

The inquiry resulted in the following: (check all that apply) No Criminal Record Available Criminal Record (Attached/Released) No NCIC/GCIC Warrant Possible NCIC/GCIC Warrant (List Wanting Agency Below)

Wanting Agency Name:

Wanting Agency Telephone:

Agency Designee Signature and Title Date

Male Female

Monroe County Board of Commissioners

Middle Name: Last Name:

City: State: Zip:

JOB DESCRIPTION

JOB TITLE: Basic Firefighter

DEPARTMENT: Emergency Services

JOB SUMMARY: This position is responsible for protecting lives and property endangered by fire and other emergency situations such as hazardous materials leaks.

MAJOR DUTIES: Suppress fires utilizing firefighting techniques such as nozzle operation, directing fire streams and ventilation.

Performs rescue activities utilizing rescue techniques such as repelling, the use of striking, prying, application of hydraulic and cutting tools.

Participates in pre-fire planning, identification of water sources and hydrant maintenance. Participates in preventative maintenance on fire equipment and apparatus

Performs routine housekeeping and maintenance activities as assigned.

Performs salvage and overhaul operations.

Assures that equipment is in proper quantities by completing apparatus check list form and performs required inventory check of items indicated: restock supply items.

Assures that the apparatus is ready to respond by returning to the station after a call, refilling the tank, reloading the hose, and complete thorough cleaning of apparatus as well as its related equipment. (If you respond to a call, you should participate in the cleanup and returning the apparatus to a response condition).

Maintains satisfactory participation including required minimum drill and call participation.

Performs other related duties as assigned.

NECESSARY KNOWLEDGE, SKILLS, AND ABILITIES:

Knowledge of hazardous materials, firefighting and rescue techniques.

Knowledge of county and departmental rules, regulations, policies and procedures.

Knowledge of city and county geography, streets and buildings.

Skill in driving in emergency and non-emergency situations.

Ability to apply firefighting and rescue techniques in a life threatening situation.

Ability to follow oral and written instructions.

Job Description (continued)

SUPERVISORY CONTROLS: Work is assigned in terms of specific instructions relating to role at the fire scene. Special duties such as pre-fire planning and training activities are assigned with more specific instructions. Complex work is reviewed for the nature and propriety of the final results and compliance with specific procedures.

GUIDELINES: Guidelines include county and departmental rules, regulations, policies and procedures. Additional guidelines include verbal and written instructions from superior officers.

COMPLEXITY: The work is often complicated by the non-routine and emergency situations encountered on fire and rescue scene.

SCOPE AND EFFECT: The purpose of this position is to protect lives and property from fire through suppression activities and public education and to provide other related service activities to the public. Effective performance results in the timely suppression of tires and minimization of accompanying losses to life and property. Errors may be in loss of life or injury, increased property damage and poor public perception of the department.

PHYSICAL DEMANDS: Fire scene activities may require lifting light and heavy objects, climbing ladders, distinguishing between shades of color, prolonged periods of walking and standing and the use of equipment requiring a high degree of dexterity. Station activities may also require the above activities.

WORK ENVIRONMENT: At a fire or rescue scene the firefighter may be exposed to hot, cold or inclement weather, extreme temperatures, hazardous situations, environments and materials which require the use of protective equipment

SUPERVISORY AND MANAGEMENT RESPONSIBILITY: None

MINIMUM QUALIFICATIONS:

Ability to meet current requirements set forth by the National Fire Protection Association and the Georgia Firefighter Standards and Training Act. ·

Volunteer Status: Must be at least 18 years of age.

Possession of or ability to readily obtain a valid State of Georgia driver's license of the class that is required by law to drive fire apparatus.

Ability to meet additional standards required by local, state and federal regulations pertaining to the position.

Documents Checklist

Name: Position:

Documents needed to begin Fire Fighter I

Resume

Driver’s License

Social Security Card

Birth Certificate

Diploma

Certifications needed by end of Rookie Class

Firefighter Certification

CPR Certification

EMR Certification

Hazardous Materials Awareness

Hazardous Materials Operations

Documents needed for State Certification

Drug Test

Finger Prints (3)

Driving History