2. What Position Are You Interested In?

   1. Fire Private
   2. Fire Cadet
   3. Explorer Program

   1. Request Recruitment Team for an Event
   2. Professional Staff
   3. Something Else
4. If you requested the recruitment team for an event, what is the name of your business/organization?
5. If you requested the recruitment team for an event, what is the date of your event?
9. First Name:*
10. Last Name:*
12. Phone Number:*
13. Email Address:*
15. Additional Details

    Help us connect you with the best recruiter by answering the questions below.

17. If you selected "Fire Private," please fill out the additional information below.
19. Date of Birth
    Date of Birth
20. Current State of Residency
    -- Select One --AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPeurto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming
22. Are you currently a firefighter in the State of Illinois?

    1. Yes

    1. No
23. Are you currently a firefighter in another state?

    1. Yes

    1. No
25. If you selected "Fire Cadet," or "Explorer Program," please fill out the additional information below.
27. Date of Birth
    Date of Birth
28. Name of School
30. Please submit your question(s) and/or summary of event request here.*
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field