4002  SCOTTSVILLE  ROAD
FLOYDS  KNOBS , INDIANA  47119
PHONE: ( 812 ) - 923 - 8003                              FAX: ( 812 ) - 923 - 1961
           
 www.ltvfd.org
WEBSITE:
We  are  pleased  that  you  have  decided  to  apply  to  become  a  Firefighter  with  the  Lafayette  Township  Fire  Protection
 District . Please  complete  the  attached  application , which  is  the  first  step  in  the  process  you  will  undergo  to  
become  an  active  Firefighter . After  you  have  completed  the  application , mail , e-mail , or hand  deliver  it  to  us . Some  
documents  that  you  will  need  to  attach  to  your  completed  application  are  outlined  on  the  Eligibility  List  
Announcement , including  your  current  driver's  license  and  any  medical , trade , or  professional  certificates  and/or  
licenses  that  you  currently  possess . Since  you  are  applying  for  a  paid  position , you  also  will  be  required  to  show  
us  proof  that  you  are  eligible  to  work  in  the  United  States  of  America .


The  attached  Firefighter  Position  Description  and  the  information  about  the  Americans  with  Disabilities  Act  are  yours
 to  keep .  

We  look  forward  to  hearing  from  you  soon !

LAFAYETTE  TOWNSHIP  FIRE  PROTECTION  DISTRICT
4002  SCOTTSVILLE  ROAD
FLOYDS  KNOBS , INDIANA   47119
www.ltvfd.org
PHONE: ( 812 ) - 923 - 8003                              FAX: ( 812 ) - 923 - 1961
           
 WEBSITE:
APPLICATION  FOR  FIREFIGHTER  POSITION
Today's  Date:
Name:
(last)
(middle)
(first)
 (Jr./Sr.)
Current  Home  Address
number/street
city,state,zip
Home  Phone:
 Cell
 Pager
LAFAYETTE  TOWNSHIP  FIRE  PROTECTION  DISTRICT
The  Firefighter  Position  Description  accompanying  this  application  describes  "Essential  Functions" , "Reasonable  
Accommodations" , "Minimum  Qualification  Requirements" , and  "Minimum  Standards  to  Maintain  Position"  for  a  
Firefighter  in  this  Fire  Protection  District .
PRINT  LEGIBLY , IN  INK . Answer  each  item  completely  and  accurately . Incomplete  answers  may  disqualify  you  or  may  
cause  delays  in  the  processing  of  your  application . FALSE  answers  may  lead  to  rejection  and/or  dismissal . Please  
write  the  letters  "NA" (Not  Applicable)  in  the  sections  which  do  not  apply  to  you . Attach  additional  pages  if  needed .