WHCEMS - Application

Application Form

Please note - You may receive an error when you click on submit but your application did go through

Is this application to become a Volunteer, Associate Member or a full time/part time Employee?

Volunteer Part Time/Full Time Employee Volunteer Associate (Currently limited

to members of the West I10 Fire
Department)

Personal Information:

Name
Address 1
Address 2
City, State, Zip
Age
E-mail
Tel
FAX
Drivers License
SSN
Education

What is your current Certification / Licensure Level?

Other:

Do you Currently Run with a 911 or transfer EMS service?

No Yes: Firm Name:

I understand that (please check as appropriate):

        I will take a drug screen Urine / Blood test
        My driving record will be checked
        My background will be checked.

I am interested in getting more information only, not in applying directly.

For Employee applicants:

Previous / Current Employer:

Name:
Address:
Please Do Do not contact my employer.

References we may contact with phone number or address:

After filling out application

Please fill out the application. When done- click on the Submit button at the bottom and we will contact you. If you are not contacted within 48 hours, please leave a message at 281-675-3600.

Thank you!

Requirements

Volunteer:
Requirements

Administrative:
Requirements

Part-Time/Full Time:
Requirements