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2. Citizens Fire Academy Application

   Complete the form below to apply for consideration to participate in the Citizens Fire Academy hosted by the Boerne Fire Department. If you have any questions about this form, please contact Lt. Toby Vicknair at [email protected].

4. Applicant Information
6. First Name*
7. Last Name*
8. Middle Name
10. Home Phone Number*
11. Alternate Phone Number
12. Email Address*
14. Home Street Address*
15. City*
16. State*
17. Zip Code*
19. Work Street Address
20. City
21. State
22. Zip Code
26. Applicant Questionnaire
28. Are you a minimum of 18 years of age?*

    1. Yes
    2. No
29. Are you eligible for employment in the United States of America?*

    1. Yes
    2. No
30. Have you served in the military?*

    1. Yes
    2. No
32. Have you ever been convicted of a felony?*

    1. Yes
    2. No
33. If you answered "Yes" to the previous question about being convicted of a felony, please provide a detailed explanation.
35. Have you pled “guilty” or “no contest” to, or been convicted of a crime?*

    1. Yes
    2. No
36. If you answered "Yes" to the previous question about pleading "guilty" or "no contest" or being convicted of a crime, please provide a detailed explanation.
38. Has your driver’s license ever been suspended and / or revoked?*

    1. Yes
    2. No
39. If you answered "Yes" to the previous question about having your driver's license suspended or revoked, please provide a detailed explanation.
41. Do you have relatives by blood or marriage employed or otherwise associated with City of Boerne/Boerne Fire Department?*

    1. Yes
    2. No
42. If you answered "Yes" to the previous question about family members, please list their names and relationship to you.
44. Please list any special skills and/or qualifications.
45. Please list any experience you have (if any) operating specialized tools and/or equipment.
47. Can you commit to attending at least 75% of the Citizens Fire Academy classes?*

    1. Yes
    2. No
48. Are you able to perform the tasks and functions of the Citizens Fire Academy?*

    1. Yes
    2. No
52. References

    List three persons who know you well enough to provide current information about you. Do not include relatives or your current supervisor. Please provide complete personal contact information in the fields provided.

54. Reference One
56. Name
57. Relationship
58. Years Known
60. Street Address
61. City
62. State
63. Zip Code
65. Phone Number
66. Alternate Phone Number
67. Email Address
69. Reference Two
71. Name
72. Relationship
73. Years Known
75. Street Address
76. City
77. State
78. Zip Code
80. Phone Number
81. Alternate Phone Number
82. Email Address
84. Reference Three
86. Name
87. Relationship
88. Years Known
90. Street Address
91. City
92. State
93. Zip Code
95. Phone Number
96. Alternate Phone Number
97. Email Address
101. Standards of Conduct

     Review the information below about Standards of Conduct for participants of the Citizens Fire Academy. Enter your full name at the bottom of the section to indicate you have read, understand and agree to abide by the Standards of Conduct as they are listed here.

     A positive training environment is maintained by commitment and discipline; preferably self discipline. Citizens Fire Academy candidates are expected to manage their own behavior in a manner that conforms to the rules and regulations of the Boerne F.D. In matters of general conduct not within the scope of B.F.D. rules, candidates should be true to the best instincts of law abiding, self respecting citizens.

     Candidates Shall:

     Follow the Standard Operating Guidelines manual of the Citizens Fire Academy

     Use their training and capabilities to educate others

     Work competently in their positions so programs operate effectively

     Conduct themselves to reflect positively on the Department and each other

     Be concerned and protective of each Candidates welfare

     Operate safely and use good judgment

     Keep themselves physically fit in mind, body and spirit

     Obey the law

     Be careful of Department equipment and property

     Candidates Shall Not:

     Engage in activities that are detrimental to the Department

     Be late

     Use tobacco products inside City buildings and / or vehicles.

     Please ask the instructors for the designated tobacco location(s)

     Enter emergency and / or non – emergency scenes without the express permission of the Incident Commander

     Participate in emergency and / or non – emergency incident stabilization activities while on a ride along

     STANDARDS OF CONDUCT ACKNOWLEDGEMENT

     I acknowledge that I have received a copy of the Boerne Fire Department Standards of Conduct. I understand that I am responsible for reading, learning, understanding and faithful execution of these standards.

     Furthermore, I agree to abide by all current guidelines, rules, regulations, procedures, policies and standards as presented and any and all future revisions. Failure to do so may result in disciplinary action up to and including dismissal from the Citizens Fire Academy. I understand that any additions and / or deletions to these standards will be subject to this agreement and acknowledgement. Failure to sign this acknowledgment will be considered resignation from the Citizens Fire Academy.

103. Full Name / E-Signature*

     Please enter you full name to indicate you agree to the terms of the Standards of Conduct.

104. Date*
     Date
108. Picture / Media Release

     I do hereby grant full and complete authority to the City of Boerne, and Boerne Fire Department, their employees, volunteers, commissioners, representatives, agents, licensees and legal representatives the irrevocable right to utilize my name, likeness, depiction, picture, photograph and/or portrait in any and all forms of media and in all manners, including composite or distorted representations for advertising, trade or any other lawful purposes. I waive any and all rights thereto, and to inspect or approve the finished version(s) including written copy that may be created and appear in connection therewith. I have read this Model Release and am fully familiar with its contents and agree to by virtues of my signature below.

     PICTURE / MEDIA RELEASE ACKNOWLEDGEMENT

110. Full Name / E-Signature*

     Please enter your full name to indicate you agree to the terms of the Picture / Media Release.

111. Date*
     Date
115. Release of Liability

     The State of Texas Kendall County

     I have applied to participate in the Boerne Fire Department Citizens Fire Academy (“Academy”) and do by virtue of my signature below, swear or attest to the following. I am at least 18 years of age, and legally capable of entering into and agreeing to this Release of Liability. I certify/attest that I have no physical or health condition or problem that could or might be aggravated or affected by my participation in Academy.

     I have been fully informed and am aware that accidents or incidents resulting in illness, personal injury, death, and/or property damage can occur in the type of activities for which I will be participating in the Academy, and could occur while I am participating in these activities.

     For and in consideration of my ability to participate and participate in the Academy, and other good and valuable consideration, the receipt and sufficiency of which is hereby confessed and acknowledged for all purposes by me, I hereby fully release, discharge, hold harmless, and indemnify City of Boerne, and Boerne Fire Department, their officers, instructors, employees, volunteers, or representatives from any and all liability, claims or causes of action, damages, judgments, or orders, of any kind or nature whatsoever, including, but not limited to, intentional acts or omissions, negligence, premises defects, contract, or any and all other causes of action for personal injury, including death, or property damage arising from or related to, in any way, my participation in the Academy, and/or in any way attributable to or from any claim of any kind which may arise or be related to my participation in any aspect or function of the Academy, including, but not limited to any illness, personal injuries, death, and/or damage to personal property or character while engaged in any and all activities affiliated with the Citizens Fire Academy. I acknowledge that all activities of the Academy are inherently dangerous and carry an inherent risk of injury, including death, or property damage. I enter into this RELEASE OF LIABILITY of my own free will, and am not influenced by any other individual or entity. I have read and understood this RELEASE OF LIABILITY and agree to it by my signature below.

     RELEASE OF LIABILITY ACKNOWLEDGEMENT

117. Full Name / E-Signature*

     Please enter your full name to indicate you agree to terms of the Release of Liability.

118. Date*
     Date
Leave This Blank:


120. 1. Receive an email copy of this form.
121. Email address

     This field is not part of the form submission.

122. Submit

* indicates a required field