WELTONVILLE VOLUNTEER FIRE COMPANY
RECRUITING
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WELTONVILLE FIRE COMPANY
APPLICATION FOR MEMBERSHIP
Name:
Address:
Phone number:
Occupation:
Employer:
Employer address:
Work phone:
Social security number:
Drivers licence number:
Age:
Date of birth:
Are you currently or have you ever been a member of another fire department?
Yes:
No:
If yes, indicate department name, phone, dates of service, and any offices you held or have held:
Please indicate the type of service you would like to provide:
Active fire fighter
Fire ground support
Public education
Training programs
Fire prevention
Emergency medicine/rescue
Vehicle/pump operator
Apprentice fire fighter (under age 18)
Other (please specify)
Have you ever been convicted of a crime? (other than traffic violations)
Yes:
No:
If yes, what was it?
Pleas list the persons who should be notified in case of emergency:(Name, Relationship and
Address)
Phone number:
I hereby make application for membership in the Weltonville Fire Company as a volunteer
firefighter. If accepted, I agree to obey the rules and regulations. I certify the information provided
on this form is true to the best of my knowledge. I understand that falsified information will be
cause for the denial of this application or termination of my membership.
Date:
Signature:
