Membership Application
Hamburg Volunteer Fire Department - Hamburg, New York
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you lived at the above address?
*
Please Select
Less than 1 Year
1 - 5 Years
6 - 10 Years
11+ Years
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you currently employed?
*
Yes
No
Name of Employer
*
Address of Employer
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number of Employer
*
Please enter a valid phone number.
Format: (000) 000-0000.
May we contact your employer as a reference?
*
Yes
No
Please indicate your availability to participate in normally required fire department activities (meetings, trainings & emergency calls)
*
Rows
Days
Evenings
Nights
Weekdays
Weekends
Please indicate membership preference(s)
*
Ambulance (EMS)
Engine & Truck (Fire)
Wherever needed / unsure
Do you have any previous emergency services experience? (Includes fire, rescue, police, and EMS agencies)
*
Yes
No
Please list your previous experience history
*
Have you been a member of the United States Armed Forces?
*
Yes
No
Are you still serving?
*
Yes
No
Did you receive a dishonorable discharge?
*
Yes
No
A dishonorable discharge is not an absolute bar to membership. This and other factors will effect a final membership decision. Please give complete details including branch and service dates.
*
Have you ever been convicted or pled guilty to arson?
*
Yes
No
Please list (3) personal references other than members of this organization whom you have known for at least 3 years.
*
Are you acquaintances with any member of this organization?
*
Yes
No
Please list their names
*
(Optional) Provide any other information you would like below.
Submit
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