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Personal Information


Background Information

  • Answering yes to any of the above questions does not necessarily disqualify you for membership.



Volunteer Information


Employment History


Additional Information


Medical Information

  • The following information is voluntary. This information will not be used solely in the decision-making process and acceptance of an Applicant. You may elect to answer only some, all, or none of the following questions.

Personal References


Completion Check List


Applicant Statement

  • I understand that: 1) If my application is accepted by the City of Bolivar, I will be required to serve a period of probation during which I will be evaluated with regard to my ability to serve as a member of the Bolivar City Fire Department (BCFD), 2) Photocopies are to be attached to this application of my driver's license, current Certificate of Insurance and/or any other certificates I may posses, 3) I am 18 years of age or older and a citizen of Bolivar living within the City limits or Special Road District, 4) The BCFD is PAID PER CALL organization under the guidance of the Bolivar City Council, and I will receive no compensation for myself other than the pay received from the City of Bolivar, 5) I am considered an employee of the City of Bolivar when serving in the capacity of firefighter with the BCFD, and as such, I shall represent the City of Bolivar and the BCFD in a professional manner, 6) I am responsible for my actions when driving or operating any fire department owned equipment and I must exercise all caution when responding to any emergency or training exercise. I will respond in a safe and prudent manner when responding in my own vehicle as well as City of Bolivar vehicles or equipment, 7) If accepted as a firefighter for the City, I will fulfill the requirements for my positions as stated in the Bolivar City Fire Department's Standard Operation Guidelines (SOG's), 8) I will follow the SOG's of the BCFD and follow the commands given by the Fire Chief or other Officers of this organization, 9) Any false information or misrepresentation on this application is reason for rejection of this application and/or dismissal from the BCFD, 10) The BCFD and/or the Bolivar Police Department may verify my employment, volunteer experience, driving record and/or criminal record through the appropriate agencies. The BCFD may also request further information or clarification as deemed necessary, and 11) By checking agree and signing this application, I do hereby give the City of Bolivar or designee permission to investigate my record of employment, volunteer experience record, and to run verification and/or record check on my driving and/or criminal record. Information received from these checks and verifications is to be held confidential by the Officers and membership committee of the BCFD. I do have the right to review the findings of those checks and verifications by submitting a written request for review to the Fire Chief of the City of Bolivar.

Authorization for Release of Personal Information

  • I do hereby authorize a review and full disclosure of all records concerning myself to any duly authorized officer of the City of Bolivar, Missouri, and its Police Department, whether the said records are of a public, private, or confidential nature. The intent of this authorization is to give my consent for full and complete disclosure of any and all records of educational institutions; financial or credit institutions; including records of loans; the records of commercial or retail credit agencies (including reports and/or ratings) and other financial statements and records wherever filed; medical and psychiatric treatment and/or consultation, including hospitals, clinics, private practitioners, and the U.S. Veterans Administration; current and previous employment records, including background reports, efficiency ratings, complaints or grievances filed by or against me; records and recollections of attorneys at law, or other counsel, whether representing me or another person in any case, either criminal or civil, in which I presently have or have had an interest; traffic and criminal history records, and records involving an incident where I have been convicted of a crime. The records referred to in this paragraph shall include, by are not limited to papers, documents, recordings, and photographs, whether on paper or stored/transmitted electronically. I understand that any information obtained by a personal history background investigation is developed directly or indirectly, in whole or part, upon this release, may be considered in determining my suitability for employment by the City of Bolivar, Missouri whether the position sought is paid or unpaid position, voluntary or educational in nature. I understand that (1) the Bolivar Police Department states that the use of such information will be in accordance with its employment policies and that such information will not be used for any other purpose other than for consideration of the undersigned as an employee of the City of Bolivar, and (2) this background investigation is required because of the nature of the particular position that I have made application for, in that it involves a sensitive position or that I may be working in an area where confidentiality and security is imperative. I also certify that any person(s) who may furnish an such information concerning me shall not be held accountable for giving this information; and I hereby release said person(s) from any and all liability which may be incurred as a result of furnishing such information. I further release any employee(s) of the City of Bolivar who conducts any part of my background investigation from any and all liability resulting from such investigation. A photocopy of this release form will be as valid as an original thereof, even though the said photocopy does not contain an original writing of my signature.


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