Rockford Fire Department Explorer Program Post 413

The Rockford Fire Department is looking for Rockford high school students to join our Explorer Post. The Program is focused on teaching the basic skills that are need to become an entry level firefighter and is open to high school juniors and seniors. The program emphasizes teamwork, professional development, and building a stronger community.

The program is now accepting applications.

The following requirements apply.

• Students must either live in the City of Rockford or attend any Rockford High School.

• Must be 16 to 18 years of age.

• Must be willing to go through an interview process, including but not limited to a comprehensive background check.

• Must be a student with a minimum GPA of 2.0, on a 4.0 scale, at the time of application. This GPA must be maintained in order to remain in the program.

First Name

Middle Initial

Last Name

Date of Birth

mm/dd/yyyy

Age

Home Address

Cell Phone

School

Grade

Emergency Contact Name

Emergency Contact Number

Second Emergency Contact Name

Second Emergency Contact Number

Parent/Guardian Name

Parent/Guardian Number

Have you ever been arrested, convicted or cited?

Character Reference #1 Name

Character Reference #1 Number

Character Reference #1 Address

Character Reference #2 Name

Character Reference #2 Number

Character Reference #2 Address

Letter of Reccomendation

I will bring

I will attach at bottom

Current Report Card

I will bring

I have attached

Signature

I hereby certify there are no willful falsifications, omissions, or misrepresentations in the forgoing statements and answers to questions. I understand that any omission or false statement on this application shall be sufficient cause for my rejection for enrollment from the City of Rockford Fire Department Explorers program.

Date of Application

mm/dd/yyyy

Parent/Guardian Approval

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