IAFF Local 2928

PROFESSIONAL FIREFIGHTERS/PARAMEDICS OF
PALM BEACH COUNTY, LOCAL 2928, I.A.F.F., INC.

CANDIDATE PRE-SCREENING QUESTIONNAIRE

NAME *

DATE OF BIRTH *

GENDER *

MILITARY SERVICE *

POLICE/FIRE/EMS SERVICE *

CAMPAIGN ADDRESS *

HOME ADDRESS *

MOBILE NUMBER *

OFFICE NUMBER *

E-MAIL ADDRESS *

PARTY AFFILIATION *

CURRENT ENDORSEMENTS

CAMPAIGN MANAGER & CONSULTANTS *

CURRENT EMPLOYMENT *

HIGHEST LEVEL OF EDUCATION *

SOCIAL MEDIA ACCOUNTS

FACEBOOK

INSTAGRAM

OTHER

OTHER SOCIAL MEDIA

HAVE YOU EVER HELD AN ELECTED OFFICE/BOARD POSITION? *

IF SO, WHICH OFFICE

IS THERE ANYTHING YOU WOULD LIKE US TO CONSIDER IN MAKING OUR ENDORSEMENT DECISION FOR YOUR CANDIDACY?

CANDIDATE SIGNATURE *

Use your mouse, finger, or touch device to write your signature.

DATE *

* Required Fields