Member Application | Whitesboro Volunteer Fire Department

Last Name *

First Name *

Middle Name *

Address *

City *

ZIP Code *

Home Phone *

Work Phone

Cell Phone *

Carrier *

Email *

1. Have you ever been convicted of a crime? *
YesNo

If yes, explain

2. Are you legally authorized to work in the U.S.? *
YesNo

3. Are you 18 years of age? *
YesNo

If not, how old are you?

4. Do you have any physical or health limitations that could interfere with your performance in the job for which you are volunteering? (Note: Assignment is contingent on applicant meeting minimum physical/mental demands of the position). *
YesNo

If you answered yes, please explain:

5. Do you have any commitments or responsibilities that might prevent you from meeting job requirements? *
YesNo

If you answered yes, please explain:

6. Do you have any relatives on the Fire Department? *
YesNo

If yes, who?

7. Have you previously applied for this position? *
YesNo

If yes, when did you apply?

Education and Training

1. High School: *

Did you graduate? *
YesNo

2. College/Trade School:

Subject Major:

Did you earn your degree?
YesNo

3. Please list any skills which you feel relate to this position:

4. Have you received Firefighter/E.M.S. training in the past? *
YesNo

Type of Firefighter/E.M.S. training:

Date:

5. Have you received first aid training in the past? *
YesNo

Type of first aid training:

Date last certified:

Driving Record Check

1. Do you agree to a driver's license record check? *
YesNo

a. Driver's license number:

State of issuance:

b. Do you have truck driving experience? *
YesNo

Type of vehicle:

c. Driver's license class-A, B, C:

d. Endorsements:

Availability and Employment History

1. What hours are you available to respond to emergency calls? *

Approximate minutes from home to Fire Station #3? *

Approximate minutes from work to Fire Station #3? *

2. Can you be available for the following meetings and training sessions?
First Monday of the month, 7:00pm-9:00pm (active and reserve) *
YesNoTuesday evening trainings from 6:30pm-9:30pm *
YesNo

3. Are you current in your fire certification? *
YesNo

If so, Date:

4. Are you current in your EMT certification? *
YesNo

If so, Date:

5. Can you attend a NYS BEFO Training Program? *
YesNo

6. Can you attend a First Responder or EMT course? *
YesNo

7. Present Employer:

Supervisor's Name:

Address:

Phone:

Job Title:

Date Employed:

Total Years Employed:

Working Hours:

Specific Duties:

Does business take you out of town? *
YesNo

If yes, please explain normally what hours are you out of town:

May we contact your employer? *
YesNo

8. Please list your Military Service if applicable:
Branch of Service:
Reserve Status:
Attendance requirements if in the Reserve or Guard:

9. Any mechanical, electrical or other specialized work experience? *
YesNo

If so, please explain:

10. References - please list three references that are not related to you.

1. Name: *

Phone: *

Address: *

2. Name: *

Phone: *

Address: *

3. Name: *

Phone: *

Address: *

Volunteer Fire Department Acknowledged Requirements

Selected applicants will be subject to a 12-month probationary period with review after six (6) months. The following must be completed or accomplished during the 12-month probationary period:

Attend monthly meetings (First Monday of each month) - Required Training Drills with the Fire Department.
Attend functions of Fire Department.
Attend fund drive.

There will be additional training required after becoming an active member of the Fire Department. Firefighters will be required to:

Start NYS BEFO course within the first year and required OSHA / Infectious Control / Workplace Violence / Sexual Harassment & NIMS.
Complete First Responder course (40 hours) or EMT training within 2 years for active members.
Attend Hazardous Material training - Attend Regional and Sectional Schools (awareness level) when offered.
Attend training as prescribed in the Fire Department Bylaws and Operation Instructions.
Being a firefighter is an emotionally challenging job and provides you with self-respect and self-satisfaction. Firefighting requires training and demands team effort and respect from each individual firefighter in the Department.

I have read these requirements and agree to them.

Date: *

Signature of Applicant: *

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Whitesboro Volunteer Fire Department
Member Application

Education and Training

Driving Record Check

Availability and Employment History

Volunteer Fire Department Acknowledged Requirements

Whitesboro Fire Department

171 Oriskany Blvd
Whitesboro, NY 13492

Phone: (315) 736-1238

Whitesboro Volunteer Fire Department Member Application

Education and Training

Driving Record Check

Availability and Employment History

Volunteer Fire Department Acknowledged Requirements

Whitesboro Volunteer Fire Department
Member Application