Department General Information Chief of Department: Tony Averbuch Telephone: 248.626.9862 Fax: 248.626.6111 Postal Address: 32707 Franklin Rd., Franklin, MI 48025

Annual Medical Statement of Personnel NOTE: This form is designed to provide the individual in charge of all personnel a complete history of physical status as of the date indicated without …

www.fbfd.com. Please attach copies of all relevant certificate and licensure to your application. Title: Elegant Letter Author: Tony Averbuch Created Date:

Franklin-Bingham Fire Department Candidate Background Investigation Authorization & Release Agreement Candidate’s Full Name_____ Date of Birth_____ Social Security Number_____

Franklin-Bingham Fire Department OSHA Respirator Medical Evaluation Questionnaire (Mandatory) Can you read (circle one): Yes/No Your employer must allow you to answer this …