CFR Personnel File Info Form
COROLLA FIRE & RESCUE SQUAD, INC.
PERSONNEL FILE
___________________________________ _____/______/_____ _________________________________
Full Name DOB Social Security Number
_____________________________________________________________________________________________
Street Address City State Zip
Phone: Home: (________)_____________________ Cell: (________)_____________________
Drivers License Number: __________________________ State _______ Expires _____/_____/____
________________________________________________________________
Employer
________________________________________________________________
Employer Address
________________________________________________________________
City/ State/ Zip
Married: Yes ____ No ____ Year: ________
Spouse’s Name: _________________________________________
Dependents:
_______________________________________ ______/_____/_____
Full Name DOB
_______________________________________ ______/_____/_____
Full Name DOB
_______________________________________ ______/_____/_____
Full Name DOB
Beneficiary:
1st ___________________________ 2nd ___________________________
Date Joined Department: ______/_____/_____ Date Terminated: ______/_____/_____
Reason for Termination: _______________________________________________________________________
Badge Number Assigned _____________________
EQUIPMENT ISSUED
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OFFICES HELD:
Title: _____________________________________________________
From Date: ______/_____/_____ To Date: ______/_____/_____
Remarks:
Other: