Accommodations for Disabilities

The Stevensville Volunteer Fire department will make reasonable accommodations

for the disabled. Individuals with disabilities requiring accommodation in the application
process, or any future department activities, MUST provide documentation of the disabil-
ity in writing to the Stevensville Volunteer Fire department Personnel Board. Applicants
needing such accommodations should document the request, including an explanation as
to the type and extent of accommodations needed to participate as a volunteer.

Are you capable of performing in a reasonable manner, without accommodations,

the Firefighting or Emt duties associated with the position for which you are applying? If
NO, what accommodations need to be provided?

YES NO
Please attach written documentation of disability, and provide accommodation needs.

Pre-Employment Physical Examination

This is to certify that the applicant named herein has been examined in confor-
mance with Montana Department of Transportation requirements by a medically approved
facility:
Name of medical facility: .
Doctors Name: . Date of exam: .

For Office Use Only

Medical approval paperwork received by: .
Date paperwork received: .

The applicant named herein has medical clearance for:

Interior Attack - Fully qualified to perform firefighter duties Including SCBA

Exterior/Fireground - Fully qualified for firefighter duties BUT NOT SCBA

EMS/QRU - Qualified ONLY for EMS duties - NO FIRE or SCBA

Emergency Contacts

In case of Emergency who should we notify?

Name: .
Day time Phone #: .
Night time Phone #: .
Address: .
.
.

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