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REPORT ILLEGAL FIREWORKS
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About
Department Profile
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Divisions
Fire Stations
Equipment
Contact Us
Education/Safety
Education/Safety Home
CERT
ReadyKern
Preparedness
Emergency Plans
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Holiday Safety
Fire Prevention
Prevention Home
Residential Inspection Requests
Building Codes and Information
Fire Hazard Reduction
Service Providers List
Fire Alarms
Permits & Apps
Permits/Apps Home
Burn Permit Requests
Resource Links
Firework Permits & Apps
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Join KCFD
Incidents
Ride-Along Program Application
Kern County Fire Department
READ THIS DOCUMENT COMPLETELY BEFORE SUBMITTING
Name
Address
Street:
*
City:
*
State:
*
Zip:
*
Phone Number
Phone
*
Alternate Phone
Email Address
Email
*
Date of Birth
Date:
*
Gender
Male or Female:
*
Select
Male
Female
Occupation
Occupation:
Employer/School
Employer/School:
Purpose for Ride Along
Comments:
Are you related to a member (active or past) of the Kern County Fire Department?
Related to a KCFD member:
Select
No
Yes
If yes, list names and relationships
If yes, list names and relationships
Do you have any physical limitations or health problems?
Limitations / Health Problems:
Select
No
Yes
If yes, describe
Comments:
Have you participated in any other Ride-Along program or are you a member of another safety agency?
Other Participation
Select
No
Yes
If Yes, which Agency and Date
Agency:
Date:
Requested Date/Time
Request:
Preferred Station/Shift
Preferred Station/Shift:
Background Authorization
I understand that a criminal check and a warrant check will be conducted as part of the application process. I hereby authorize any law enforcement agency, agencies of the government of the United States of America, and agencies of the State of California to release to the Kern County Fire Department any and all information which said agencies or any of them have about me, for the limited purpose of aiding the Kern County Fire Department in evaluating my eligibility for participation in the KCFD Ride-Along Program. This release extends to any and all information which said agencies or any of them have about me, whether public, personal, or confidential. I understand that I will not receive and am not entitled to know the contents of confidential reports received from these agencies and I further understand that these reports are privileged. I hereby release, discharge, and agree to hold harmless the agencies, their agents and representatives and any person furnishing information from any and all liability of every nature and kind arising out of the furnishing and inspection of such documents, records and other information, and this release shall be binding on my legal representatives, heirs assigns.
I have read the Background Authorization statement and agree to it in its entirety
*
Yes
Submit
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