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Survey/Form Review
Citizens Fire Academy Application
1. Name:

2. Street Address:

3. City:

4. State:

5. Zip:

6. Home Phone:

7. Cell Phone:

8. Employer:

9. E-mail address:

10. How long have you lived in Brentwood:

11. Date of birth: (mm/dd/yyyy)

12. Sex:*
13. Shirt Size:*
14. Why do you want to attend the Citizens Fire Academy:

15. How did you hear about the Citizens Fire Academy:

16. Have you ever been convicted of a felony? *
17. Have you ever been convicted of a felony involving moral turpitude?*
18. Do you have any severe physical limitations which would hinder you from engaging in activities associated with the Citizens Fire Academy:*
19. I am willing to undergo a minimum background investigation by the City of Brentwood Police Department due to the sensitivity and nature of some of the information that will be covered during the course of training.*
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