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CIVICPLUS TRAINING

Fire Department

Work Order Form

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Lawrenceburg Fire Department Citizen's Fire Academy Application

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Name*
Enter first and last name.
Date of Birth*
Use format : xx/xx/xxxx
Street address*
City*
State*
Zip*
Home Phone*
use format : ###-###-####
Cell Phone*
Employer*
Email Address*
How long have you lived in Lawrenceburg/Lawrence County?*
Gender*
1. Male
2. Femail
3. Prefer not to answer
Shirt Size*
Why do you want to attend The Citizen's Fire Academy?*
How did you hear about The Citizen's Fire Academy?*
Have you ever been convicted of a felony?
1. yes
2. no
Have you ever been convicted of a felony involving moral turpitude? *
1. yes
2. no
Do you have any severe physical limitations which would hinder you from engaging in activities associated with the Citizen’s Fire Academy? *
1. yes
2. no
I am willing to undergo a minimum background investigation by the Lawrenceburg Police Department due to the sensitivity and nature of some of the information that will be covered during training. *
1. yes
2. no