Be a Volunteer for UTFPD - Utica Township Fire Protection District

Full Name

First

Last

Date of Birth

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Email Address

Phone Number

DL#, State Issued, Exp Date

Permission for Background Check

I authorize the department to conduct a background check as part of my application process.

Do you live in Utica Township? (not required)

Do you have previous firefighting experience? (not required)

If yes, please describe your experience

Number Do yes,

Are you currently a member of a Fire Department?

Department Name

Please specify the name of your current Fire Department.

Certifications if any

EMT Certification Number

Please enter your EMT certification number.

Please specify your certification

If you selected ‘Other’, please specify your certification.