Long Lake Volunteer Fire Department Logo
  • Long Lake Volunteer Fire Department

    Application for Membership
  • Long Lake Volunteer Fire Department 

    4113 Pontoon Rd, Pontoon Beach IL 62040

    618-931-2655

    Fire Chief Terry Kreher

    Assistant Fire Chief David Klee

  • Personal Information

  • Drivers License #: *

    Expiration Date:   *   

    Class of License:   *   

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  • Resided in the Long Lake Fire Protection District for at least 1 year prior to submitting of this application?      *   If yes, how long?   *   

  • Work Schedule:       r

  • Have you ever been convicted of a Felony?      *   

  • Military Service?      *   

  • Any Fire Service History?      *   

  • If yes, May we contact your former Chief?      *   

  • Have you taken any educational classes pertaining to to Fire & EMS?
       *   

  • I agree by signing this application to the Long Lake Volunteer Fire Department, I will abide by the Constitution and By Laws of the Long Lake Volunteer Fire Department. I understand that any failure to do so may result in my dismissal from the department. I understand that any department property must be returned should I leave the department.

    I understand that once my application has been accepted, I will need to take and pass a Physical Examination and Drug test (paid for by the department). I understand that failure to complete and pass both tests will result in my removal from the department.

    All answers and statements are true in every detail to the best of my knowledge and belief. I understand that by signing this application, I further authorize the Long Lake Volunteer Fire Department to obtain, copy, secure, photograph, and review all records, data and information relating to me, my arrest record, my traffic record, my credit record and my medical records to enable the said department to conduct a full and complete background investigation on my person. I absolve and agree to hold harmless any individual, organization, agency or institution who supplies said records,
    data or information to said department from any liabilty of whatever nature and from
    cause of action which might arise from said actions.

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