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BRASHER-WINTHROP VOLUNTEER FIRE DEPARTMENT APPLICATION

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BRASHER-WINTHROP VOLUNTEER FIRE DEPARTMENT APPLICATION

708 STATE HIGHWAY 11C WINTHROP NY, 13697
P.O BOX 11 WINTHROP NY, 13697

Email *

APPLICANTS NAME
*

ADDRESS
*

PHONE NUMBER
*

EMAIL *

DATE OF BIRTH
*

SOCIAL SECUIRTY# * FOR BACKGROUND CHECK

DRIVERS LICENSE#
*

DRIVERS LICENSE CLASS
*

HOW LONG HAVE YOU BEEN A RESIDENT OF THE BRASHER-WINTHROP FIRE PROTECTION? YRS/MTHS
*

ARE YOU EMPLOYED?
*

YES

NO

IF YES ABOVE EXPLAIN

DO YOU WORK SHIFT WORK?
*

YES

NO

ARE YOU COMFORTABLE WITH CLIMBING?
*

YES

NO

ARE YOU COMFORTABLE INCLOSED PLACES?
*

YES

NO

HAVE YOU DONE ANY HEAVY TRUCK DRIVING?
*

YES

NO

HAVE YOU EVER BEEN CONVICTED OF A CRIME?
*

YES

NO

IF YES ABOVE EXPLAIN

DO YOU HAVE A VALID NYS DRIVER’S LICENSE?
*

YES

NO

WILL YOU BE ABLE TO ATTEND FIRE SCHOOL (BEFO 79 HRS) WITHIN ONE YEAR?
*

YES

NO

DO YOU HAVE FIREFIGHTING CLASSES/CERTIFICATIONS?
*

YES

NO

IF YES ABOVE EXPLAIN WHAT CLASSES/CERTS

DO YOU UNDERSTAND THE DUTIES OF A FIREFIGHTER?
*

YES

NO

WILL YOU BE ABLE TO ANSWER FIRE CALLS FROM YOUR PLACE OF EMPLOYMENT?
*

YES

NO

DO YOU BELONG TO ANY OTHER CIVIC ORGANIZATION?
*

YES

NO

IF YES ABOVE EXPLAIN

IS YOUR FAMILY IN AGREEMENT WITH YOUR JOINING OF THE BRASHER-WINTHROP FIRE DEPT REALIZING THE AMOUNT OF TIME THAT MAY BE REQUIRED OF YOU?
*

YES

NO

WHY DO YOU WANT TO BE A MEMBER OF THE BRASHER-WINTHROP FIRE DEPT?

*

DO YOU HAVE ANY MEDICAL LIMITATIONS?
*

YES

NO

IF YES ABOVE EXPLAIN

1ST BWFD MEMBER SPONSOR
*

2ND BWFD MEMBER SPONSOR
*

1ST NON MEMBER REFERENCE
* ADD PHONE NUMBER

2ND NON MEMBER REFERENCE * ADD PHONE NUMBER

I,________________________________ FORMALLY SUBMIT MY APPLICATION FOR MEMBERSHIP IN THE BWFD. I ACKNOWLEDGE THE SERIOUSNESS OF THE OBLIGATIONS TO WHICH I COMMIT MYSELF AND ATTEND ALL FIRES, MEETINGS AND OTHER DEPARTMENTAL AFFAIRS WITHIN MY ABILITY. I SHALL FOLLOW THE CONSTITUTION OF THE FIRE DEPARTMENT AND OBEY ITS OFFICERS AND SUBMIT TO A BACKGROUND CHECK. *

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BRASHER-WINTHROP VOLUNTEER FIRE DEPARTMENT APPLICATION

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