COROLLA FIRE & RESCUE SQUAD, INC.

PERSONNEL FILE

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Full Name Date of Birth

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Street Address Social Security Number

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City, State, ZIP Phone

Drivers License Number: __________________________ State _______ Expires _____________

Employer ___________________________________________________________________

Address __________________________________________________________________

City _____________________ State ________________ Zip __________________

Married: Yes ____ No ____ Year: ________ Spouse’s Name: ________________

Dependents: ____________________________ ______________________________

Name DOB Name DOB

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Name DOB Name DOB

Beneficiary: 1^st ___________________________ 2^nd ___________________________

Date Joined Department: _________________ Date Terminated: __________________

Reason for Termination: _____________________________________________________

Badge Number Assigned _____________________

EQUIPMENT ISSUED

Item S/N or Size Date Issued Date Returned

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OFFICES HELD

Title From Date To Date Remarks

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Other: