Membership Application

Rennerdale Volunteer Fire Department Membership Application

This application is to become a member of the Rennerdale Volunteer Fire Department. There are three levels of membership that you can apply for:

Junior Fire Fighter (Ages 14 to 18)
Active Fire Fighter (Age 18 and up)
Social Member (Want to help department but not run fire calls)

Please provide your information below. You must provide an answer to all questions in order to submit your application. If you cannot or the question does not apply to you please indicate with N/A.

When you are done please select submit at the bottom of the page.

When your membership application has been reviewed someone will contact you.

Thank You.

Registrant Information

First Name:

Last Name

Address

City, State Zip:

Phone:

Email:

Cell Phone Number:

Date Of Birth:

Age:

Emergency Contact Information

Contact Name:

Contact Number:

Education

Level Of Education (Please provide highest level of education):

Please list any other education you are attending or have completed

Driving Information (If you do not have a drivers license, put N/A)

Driver's License Number:

Non CDL Class:

CDL Class:

Employment Information

Employer:

Employer Address:

Occupation:

Days & Time You Work:

Please list all Fire and/or EMS organizations with which you are or have been affiliated with. Please indicate active or not active and rank. (If none please indicate with N/A)

Other Fire Or EMS:

Please list all Fire and/or EMS training you have had and include what certificates you hold. (If none please indicate with N/A)

Fire / EMS Training:

Please list any other training or qualifications that may benifit you as a member. (If none please indicate with N/A)

Other Training / Qualifications:

Has your driver's license ever been revoked or suspended for any Reason? (Please answer in the space below yes or no followed by a brief description)

Have you ever been convicted (or received a prayer for judgement continued) for driving while impared (DUI) or for wreckless driving? (Please answer in the space below yes or no followed by a brief description)

Have you ever been convicted of any other moving violations? (Please answer in the space below yes or no followed by a brief description)

Have you ever been arrested or convicted of a felony or criminal misdemeanor? (Please answer in the space below yes or no followed by a brief description)

All new membership applicants must be sponsored by a current member. Please indicate who is your sponsor. If you do not have a sponsor or are new to the area please indicate as none or new to area.

Sponsor:

Type of Membership you are applying for:

Comments:

I certify that the information given above is true and accurate to the best of my knowledge.

I understand that providing false or incomplete information is grounds for membership termination.

I understand that my driving and criminal record may be checked at any time.

I understand that I may be asked to submit to a drug or alcohol test at any time.

I understand that even though I am a volunteer I am expected to attend all training, meetings and respond to calls when I am available to.

I understand that I am prohibited from attending training, meetings or responding to calls while under the influence of drugs or alcohol and is grounds for membership termination.

I understand that my membership with the Rennerdale Volunteer Fire Department is a privilage, that I will be part of an elite organization, that I am expected to maintain a possitive image in the public view.

Agreement (required)

I have read and agree to all terms and conditions above

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Rennerdale Volunteer Fire Department Membership Application

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