(Click on Link for Printable Application)
ST. PAUL BLVD. FIRE ASSOCIATION, INC.
ROCHESTER NEW YORK 14617
APPLICATION FOR ST. PAUL BLVD. VOLUNTEER FIREFIGHTER
Qualified applicants are considered without regard to race, color, creed, sex, national origin, age, marital or veteran status.
Date of Application ___/___/_____ SS# ________________________________________
(last) (first) (middle)
Address __________________________________________ ZIP Code _____________________
Previous Address __________________________________ ZIP Code _____________________
Phone # ___________________________________________ Cell # _______________________
Have you previously filed an application with this organization? ( )Yes ( )No
Have you any previous firefighting experience? ( )Yes ( )No
Are you a citizen of the United States? ( )Yes ( )No
If not, do you possess an Alien Registration Card? ( )Yes ( )No
Do you have any friends or relatives who are presently members of this organization? ( )Yes ( )No
If yes, list name(s) ______________________________________________________________________________________________________________________________________________________________________________
Have you ever been convicted of a misdemeanor or felony? ( )Yes ( )No
Have you ever been convicted of an arson-related crime? ( )Yes ( )No
Are you a veteran of the United States Military Service? ( )Yes ( )No
Do you have any physical, mental or medical impairment or disability that would limit your ability to be a volunteer firefighter? ( )Yes ( )No ( )Maybe
If necessary, please explain _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
APPLICATION FOR ST. PAUL BLVD.VOLUNTEER FIREFIGHTER
Are you presently a member of any other civic organization? ( )Yes ( )No
If yes, please list ________________________________________________________________________________________________________________________________________________________________
Please give name, address and telephone number for two references not related to you.
Education Years Completed _____________ Diploma/Degree _______________
Specialized training, skills _______________________________________________
Your current employer:
Name _______________________________________ Phone Number _________________
Driver License Number ___________________________ (Copy needed for reference)
Availability for Membership ( )Day Worker ( )Trick Worker
Are you able to attend evening meetings and drills? ( )Yes ( )No
If no, please explain ______________________________________________________
Consent for Disclosure
I, _____________________________________________ give the investigating Officer of the St. Paul Blvd. Fire Association my consent to make inquiries of my employers, neighbors, police agencies and insurance carrier while conducting an investigation of my character, past record and responsibly
Signature of Applicant _________________________________ Date ________________
Comments of Investigating Officer: ( ) ACCEPT ( ) REJECT
Interviews are conducted on the 4th Tuesdays of each month.
You will be contacted by our membership chairperson to confirm your attendance at the interview meeting.
Please seal your application in the attached envelope and return the envelope to our Cooper Road firehouse within 7 days after picking up the application.
Thank you for interest in joining the St. Paul Boulevard fire Association!