South Santa Clara County
Fire District
www.ssccfd.org
First name:
 Last name:
Street:
City:
 Zip:
Birth date:
E-mail Address:
Home Phone:
 Cell Phone:
Do you possess a Class B drivers license? (Not Required):
 Yes
 No
                    Commercial Drivers License Expiration Date:
DOT Medical / FF Restricted Questioner Expiration Date:
                                 Do you have a Tank Endorsement?
 Yes
 No
Do you have previous firefighting experience? (Not Required):
 Yes
 No
Are you a current First Responder, EMT, or Paramedic? (Not Required):
 Yes
 No
Are you interested in becoming a Firefighter Associate? :
(Associates assist PCF with no medical or fire experience needed)
 Yes
 No

Important Please Read, Then Submit:

I understand, by filling out this interest form, I am in no way guaranteed employment by
the South Santa Clara County Fire District, Paid Call Firefighters. This form is only to
express interest in applying for a possible firefighter position. I also understand that this
interest card will be maintained by the PCF for no more than 2 years.
Paid Called Firefighters
Interest Form
The South Santa Clara County Fire District/Paid Call Firefighters are a professional group that
strives for the best in everything they do. If you feel that you can meet the challenge and want to
join the best, fill out this form completely. Should we have an opening, we’ll send you an
application package and then, maybe you’ll become one of us, a Paid Call Firefighter.