Lake Carmel Fire Department, Inc.

851 Route 52
Carmel, NY 10512
Phone: (845) 225-3730, Fax: (845) 225-0460
www.lcfd.com

100% Volunteer since 1945

Application for Membership

General Guidelines/Requirements:
- Applicants must be over the age of seventeen (17) and under the age of sixty-two (62) on the day of acceptance. Applicants under the age of eighteen (18) must submit parental permission.

- All applications are subject to review by our membership committee and the Kent Town Board.

- Applicants will be subject to Arson, DMV, and Criminal Background checks.

- All applicants must take an initial medical exam. Applicants will be directed to do so after they've been initially reviewed for approval. A Chief will contact you at the appropriate time with details.

- A copy of your NYS driver's license MUST accompany this application.

If you have any questions, please contact the Chief
at (845) 225-3730 Ext. 81711

Date of application*

Date

First Name*

MI*

Last Name*

Address

Street Address PO box NOT accepted

Street Address Line 2

CityState

Zip Code

Phone Number*

Format: (000) 000-0000.

Cell Number*

Format: (000) 000-0000.

Email Address*

example@example.com

Social Security Number*

Date of Birth*

Date

NYS Drivers License Number*

Date of Expiration*

Date

2. Mailing Address (if different than legal address)

Address

Street Address PO box accepted

Street Address Line 2

CityState

Zip Code

3. Select the appropriate answer to the right of each question:*

Rows	Yes	No
Have you ever been dismissed or discharged from any employment for other reasons other than work or funds?
Have you ever reassigned from any employment rather than face dismissal?
Have you ever been convicted of any crime (felony or misdemeanor)?
Have you ever forfeited bail bond posted to guarantee your appearance in court to answer to any criminal charge?
Are there any arrests or criminal accusations currently pending against you?

If you answered "YES" to any question(s) above, please use space below to give specifics. If you elect not to provide an explanation, you may be disqualified, or if such explanation is insufficient, you may be required to submit further information.

4. Occupation - List current employment, followed by previously employer*

Rows	Name of Company	Years there	Reason for leaving
Company 1
Company 2

5. Education:

High School*

Year Graduated*

College

Type of Degree

Program

Year Graduated

Other Educational Courses

6. Personal references - three (3) required:*

Rows	Name	Address	Contact #
Reference 1
Reference 2
Reference 3

7. List any Fire/EMS Training and or certifications (If none leave blank)

Rows	Certification	Date Certified	Date of Expiration
Certification 1
Certification 2

8. Membership in other organizations past or present - including Fire Departments/VAC (If none leave blank)

Rows	Organization	Location	Years there	Contact Person
Department 1
Department 2

9. Military Service (If none leave blank)

Branch

Years of Service

Type of Discharge

10. Emergency Contact Information

Next of Kin*

Contact Number*

Format: (000) 000-0000.

Relationship*

Other Hobbies or Skills*

Rows	Hobbies/Skills
Hobby/Skill 1
Hobby/Skill 2

Full Member: Any person 18-62 years of ageJunior Member: Any person 17 years of ageAdministrative Member: Individual performing administrative duties for Lake Carmel Fire Department

I hereby apply for membership in Lake Carmel Fire Department Inc. I certify by my signature that the information provided is true and complete. I further agree to uphold the bylaws and Standard Operating Guidelines of the organization and will abide by its rules. I agree to properly maintain any property entrusted to me and to return all fire department property in good condition promptly when directed to do so or upon my resignation/termination of membership.

Parent/Guardian Authorization
The above information is accurate and the described has permission to participate as a probationary member in the Lake Carmel Fire Department. In the event of illness or injury in the course of such activity, I request that measures be instituted without delay as the judgment of medical personnel dictates.

Applicant Name*

Date*

Date

Sponsoring Member Name

*Junior Members Only*

Parent/Guardian Signature

Date

11. Putnam County Sheriff's Department Authorization For Release of Records Form

Full Name*

Signature*

Date*

Date

Drivers License (Front)*

Drivers License (Back)*

What To Expect As a Member

1. The Lake Carmel Fire Department, Inc. provides fire and ambulance service to the community, twenty-four (24) hours a day, seven (7) days a week (holidays included The service is 100% volunteer. Over the past several years, we've averaged over 250 fire calls for help and over 550 EMS calls for help per year. We rely on a strong foundation of volunteer members to provide fire and EMS service at any given time. We currently do not incorporate shifts for volunteers except for EMS service, Sunday through Thursday from 10pm to 5am. During your probationary period, you will be exposed to both our fire and EMS operation and have a choice to decide whether you want to help with either fire AND EMS operations or just one aspect (fire OR EMS) of our service to the community.

2. The probationary period is six (6) months long. During this time, you're expected to gain an understanding of our operations. You will not be allowed to be directly involved in any operation that can be dangerous to your health until properly trained, but you will be exposed to any operation during that period in which you're available to help. You will be used as secondary support.

3. At the end of your probationary period, you will have two (2) years to either complete the New York State Firefighter I program (86 hours) or the New York State Emergency Medical Technician program (140 hours These training courses are offered (in county) at no cost to the member and are offered during times which allow for a typical work schedule.

4. Training doesn't stop after the state minimum requirements are met. We provide department level training throughout the year. We have a monthly training drill the second Thursday of every month starting at 7:30pm and individual unit training every Sunday from 10am to 12 pm. Members are required to meet the minimum requirements as set by the Chief of the department and the training committee.

5. There is a general meeting held the first Thursday of every month starting at 8pm. Members are expected to attend as information in regard to fire/EMS operations and general administrative operations is provided.

6. Any equipment needed to be a member will be provided for your protection at no charge to the member. Typical equipment issued to individual members includes, but is not limited to a full set of turnout gear (fire or EMS), a uniform and a pager with charger.

7. As volunteers, pagers are our primary means to be notified of an emergency call. Pagers are the size of a cell phone and are carried and charged just the same. After a call is received from Putnam County 911, an alert is sent out which is picked up by the pagers. At that point, if you're available and within a reasonable distance to respond, you're expected to help.

8. Duration of the calls vary depending on the type and size of the incident. Typical EMS calls average one and a half hours of your time from the time you are notified to the time you get back to quarters. Fire calls are not so typical. A minor event can take only a half hour to complete while a major incident can take several hours to complete.

These are just some general topics of what to expect as a volunteer member of the Lake Carmel Fire Department. There are many other facets of being a volunteer that can be learned as you fulfill your time as a member. We consider ourselves family oriented and have functions to reflect that. Becoming a volunteer can be a rewarding experience. Now that you've taken the next step in getting this application, make some time to become a member and be a part of our family. It's an experience you will not regret!

If you have any additional questions, please contact the Chief at (845) 225-3730 Ext. 1711.