First Name
Last Name
Date of BirthRace
--None--African AmericanAsianCaucasianHispanic2 or more racesOther

Gender
--None--FemaleMale

Address
City
State/Province
Zip
Phone
Email

How were you referred to the Austin Fire Department?
--None--Word of Mouth (Friends, Family, etc)AFD RecruiterInternet SitePrintTelevisionRadio

By May 23, 2012, will you have graduated from High School or obtained a GED?
--None--YesNo

By May 23, 2012, will you have earned or been credited with at least 15 credit hours with a GPA of at least 2.0 from an accredited 2 or 4 year college or university?
--None--YesNo

By May 23, 2012, will you have served at least 2 years of continuous service with a branch of the US Military, Military Reserves, or National Guard?
--None--YesNo

Have you ever been convicted of a felony?
--None--YesNo

Have you had a conviction for any Class A or Class B misdemeanor?:
--None--YesNo

Please provide Class A/B misdemeanor conviction date (Type NA if not applicable) Are you currently under indictment for, currently charged with, or on probation for any offense?
--None--YesNo

Have you been convicted of more than one misdemeanor
--None--YesNo

Have you illegally used any controlled substance or illegal drug, including Marijuana in the last three years?
--None--YesNo

Thank you for submitting your Candidate Interest Card to the Austin Fire Department. Should you not receive an email confirmation, please resubmit your interest card as there may be a error with your contact information.