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Citizens Fire Academy

  1. If selected, you will be asked to sign a waiver of liability and hold harmless agreement, which will need to be notarized.

  2. mm/dd/year

  3. In order to be eligible for the Citizen's Fire Academy, you must meet at least one of the following criteria.*

    Check all that apply

  4. Emergency Contact Information

  5. Please review your answers carefully and read the following statement before agreeing to the application*

    LITTLE ELM FIRE DEPARTMENT CONSENT FOR CRIMINAL BACKGROUND HISTORY AUTHORIZATION /WAIVER / INDEMNITY Each person who has applied for educational, training, and/or community service activities with the Little Elm Fire Department, including but not limited to Citizens Fire Academy, Community Emergency Response Team, Little Elm Fire Department Auxiliary and/or Little Elm Box 620 Support Co., who is to be screened must sign an authorization/waiver/indemnity form, giving approval for the Town of Little Elm to perform a background search. I hereby give my permission for the Town of Little Elm to obtain information related to my background and motor vehicle record. The background record, as received from the reporting agencies, may include arrest and conviction data as well as plea bargains and deferred adjudication. I understand that this information will be used in part to determine my eligibility for educational, training, and/or community service activities with the Town of Little Elm. I also understand that as long as I participate in educational, training, and/or community service activities with the Town of Little Elm, the background and motor vehicle records check may be repeated at anytime. I understand that I will have an opportunity to review the background, if I dispute the record received. I, the undersigned, do, for myself, my heirs, my executors and administrators, hereby remise, release and forever discharge and agree to indemnify the Town of Little Elm and each of their officers, directors, employees, and agents harmless from and against any and all causes of actions, suits, liabilities, costs debts and sums of money, claims and demands whatsoever, and any and all related attorney’s fees, court costs, and other expenses resulting from the investigation of my background in connection with my application to participate in educational, training, and/or community service activities.

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