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Firefighter/Paramedic Orientation Registration Form

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Step One

Firefighter/Paramedic Orientation Registration Form

VILLAGE OF ROMEOVILLE
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Contact Information:

Last Name:
First Name:
MI:
Date of Birth:
Date of Birth:
Street Address:
City:
State:
Zip Code:
Primary Phone:
Secondary Phone:
The following data is being gathered in compliance with Federal Equal Employment Opportunity Commission Regulations. The law requires that your response is voluntary and will not affect employment action. The information you supply is not for personnel records.
Thank you for your cooperation.
Sex:
1. Male
2. Female
Race of Natural Origin:
1. White
2. Black or African American
3. American Indian or Alaska Native
4. Asian
1. Native Hawaiian or Other Pacific
2. Hispanic
3. Other
If other, please explain:
I hereby attest that I have been notified of the date, time and location of the Orientation.
Signature:
Date:

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Contact Us

1050 West Romeo Road
Romeoville, IL 60446
Phone: 815-886-7200
Monday - Friday 7 a.m. - 4 p.m.

Village Hall: 815-886-7200
Fire Department: 815-886-7227
Police Department: 815-886-7219
Public Works: 815-886-1870
Recreation Center: 815-886-6222
Water Billing: 815-886-7212

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