Date: Name:
____________________________________________________________________________
Address:
____________________________________________________________________________
Home Phone: Work Phone:
____________________________________________________________________________
Fax: E-Mail:
____________________________________________________________________________
Occupation: Employer:
____________________________________________________________________________
Drivers License:
____________________________________________________________________________
How long have you been a resident?
____________________________________________________________________________
Hobbies or Special Interests:
____________________________________________________________________________
____________________________________________________________________________
Why would you like to attend the C.E.R.T training and be a part of the team?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Can you commit to all of the classes? Y or N
____________________________________________________________________________
I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statements and answers to questions. I understand any omissions or false statements on the application shall be sufficient cause for rejection of enrollment dismissal from the "Community Emergency Response Team".
I further understand the Town of Hull Community Emergency Response Team will be conducting a background review that may include, but not limited to any criminal history.
Signature: Date:
_______________________________ _________________
Please return application to:
C.E.R.T.
Hull Fire Department
C/O Mrs. Jane Walsh
671 Nantasket Avenue
Hull MA, 02045
| 
