WH FD Application

WINTER HARBOR FIRE DEPARTMENT

APPLICATION FOR MEMBERSHIP NO EXPERIENCE NECESSARY
Applicant Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived at this address?
*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Person To Contact In Case of Emergency? First Name* Last Name*
Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contact Relationship*
Do You Have a Valid Driver's License?*
If Yes License # Class of License Restrictions If Any
Do You Have Any Prior Firefighting Training and Experience? If So, Please Give a Brief Explanation:
Do You Have Any EMS Training and Experience? If So, Please Give a Brief Explanation:
List Any Other Special Qualifications You Have That Would Benefit the Department
Please list two references that we may contact:
First Name Last Name Area Code Phone Number
First Name Last Name Area Code Phone Number
If Accepted for Membership You Will Be Put on Six Months', During Which Time You Will be Required to Attend All Meetings, Trainings's, And Answer as Many Calls as Possible. At The End of That Six Months, You Will Receive a Final Vote for Full Membership. To Remain on The Active List, You Must Attend a Minimum of Four Monthly Meetings, and Twelve Hours of Training Anually. Also, You Must Abide by The By-laws of The Department, And the Laws of The State of Maine.

If You Freely Submit This Application and Agree to The Above Conditions, Please Sign Below.
Signature

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Date

MonthDayYear
Date
Department Use only

Date of receipt _____________ Date of acceptance into department ____________

Start of probation ____________ End of probation _________________

Chief Signature _____________________________ Date _______________
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WINTER HARBOR FIRE DEPARTMENT