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?

*IF YES ABOVE EXPLAIN*

DO YOU WORK SHIFT WORK?

ARE YOU COMFORTABLE WITH CLIMBING?

ARE YOU COMFORTABLE INCLOSED PLACES?

HAVE YOU DONE ANY HEAVY TRUCK DRIVING?

HAVE YOU EVER BEEN CONVICTED OF A CRIME?

*IF YES ABOVE EXPLAIN*

DO YOU HAVE A VALID NYS DRIVER’S LICENSE?

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

DO YOU HAVE FIREFIGHTING CLASSES/CERTIFICATIONS?

*IF YES ABOVE EXPLAIN WHAT CLASSES/CERTS*

DO YOU UNDERSTAND THE DUTIES OF A FIREFIGHTER?

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

DO YOU BELONG TO ANY OTHER CIVIC ORGANIZATION?

*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?

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

DO YOU HAVE ANY MEDICAL LIMITATIONS?

*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. *