NFR User Profile

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Attachment 3b. User Profile

User Profile Questions
    • What is your full name?
        ◦ First: _______________________
        ◦ Middle: _____________________
        ◦ Last: ______________________________________________
    • Have you been known by any other name (example, maiden name)?
        ◦ No
        ◦ Yes
            ▪ [If yes] Other First Name ______________ Other Last Name ______________
    • What is your current residential address?
        ◦ Street: ________________________
        ◦ Apt/Suite/Other
        ◦ City: __________________________
        ◦ State: (scrolling menu) ____________
        ◦ Zip code: ______________________
    • We have the following email address listed above on file. Would you like to provide another email address that will be used to contact you if we cannot reach you at the primary email address?.
        ◦ __________________________________
    • If you would also like to receive updates via text message, please opt-in and provide your mobile number below 
        ◦ (xxx)xxx-xxxx
    • What is your current work status in the fire service (select all that apply)?
        ◦ Full time paid
        ◦ Part time paid
        ◦ Volunteer (full or part time)
        ◦ Seasonal
        ◦ Paid on call or paid per call
        ◦ Retired
            ▪ In what year did you retire (approximate date) ? _  _  _  _
        ◦ No longer working in the fire service
            ▪ In what year did you stop working in the fire service (approximate date)?
        ◦ Academy Student
        ◦ Out on long-term disability
        ◦ Other
            ▪ If other, please specify ___________________________