EmailMe Form - Brunswick 2018 Citizens Fire Academy

Name *

First Last

Address *

Email *

Cell phone *

### - ### - ####

Ohio Driver's License Number *

Profession/work activity *

Are you a resident or business owner in Brunswick? (Check one.) *

Resident

Business owner

Both

How long? *

If business owner, please provide business name and address.

Briefly describe why you are interested in participating in the Citizens Fire Academy. *

Maximum class size is 15 participants. A limited background check will be done on each applicant. The Brunswick Division of Fire reserves the right to deny entry to the Academy based on the findings of a background check. All information on the above application is true. I authorize the Brunswick Division of Fire to conduct a background check based on this application.

Signature *

Clear

Date *

MM / DD / YYYY

For more information call Fire Chief Jim Baird at 330-273-8046 or email jbaird@brunswick.oh.us