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Firefighter of the Year Application

A cover letter from entity making nomination and this entry form must be included

                                                                                  to earn full points in judging.

  Name of Nominee: ______________________________________________ Telephone: _________________________________

  Home Address: _________________________________________________ City: ________________________ Zip: ___________

  Fire Department: ________________________________________________ Fire Chief: _________________________________

  Department or County Association submitting nomination: _________________________________________________________

  Chief of Dept. or President of Association submitting nomination: ____________________________________________________

  Address:_______________________________________________________ City: ________________________ Zip: _______________

  Phone numbers_____________________________________________________________________________________________                                                     


Information about Nominee: 

           • Please answer all questions and provide any additional pertinent information about the nominee on an attached letter.

  Fire Department years of service: ___________________________________ Volunteer: _____ Paid on call: _____ Paid: _______   

  If Volunteer, Nominee’s       occupation: ___________________________________________________________________________   

  Leadership - Elected positions held in Dept.

  Position: ______________________________________________________ Number of years:  _____________

  Position: ______________________________________________________ Number of years:  _____________

  Member of Rescue Squad/Ambulance:   Yes  ____   No  ____   First Responder/EMT  Yes  ___  No ___  Number of years _______    

  

  List all training courses completed: Must provide copies of documentation (certificates, transcripts, etc.) to earn full credit:

  _________________________________________________________________________________________________________

  _________________________________________________________________________________________________________

  _________________________________________________________________________________________________________

  _________________________________________________________________________________________________________

  Complete percentage of attendance record:        Fire calls ____________________%              Rescue calls _________________ %

                                          Department meetings and training sessions _____________________________%

                                                       • Provide additional information about the nominee on an attached letter.

  Describe significant accomplishments or acts of heroism in past 18 months  (Must include documentation and a letter from Chief   of department or, if Chief      is nominee, a letter from Assistant Chief).

  Include at least two character references other than department members (attach separate letters).

  Fire Safety Programs involvement.

  Community service other than Fire Department activities (American Legion, Church, Youth, etc.).

  Any special activities/service not listed: (Armed services, Peace Corps, etc.).

   Please attach a letter with additional pertinent information. The winner and spouse will have all expenses paid at the convention  and receive a    plaque in     their honor.   A certificate only will be presented to all qualifying entries submitted.    Send to WSFA, PO Box 267, Mazomanie, WI 53560

Winner will be selected through a point system; highest number of points is the winner.

Deadline December 21, 2018

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