MEMBERSHIP APPLICATION | Beechwood Volunteer

Beechwood Volunteer Fire Department Membership Application Form

First name

Last name

Phone

Drivers License #:

Example: Z00-000-0000-00

Address

How long have you lived at above address?

Do you live in the village of Beechwood, Batavia, or Town of Scott?

Occupation:

Employer:

How long have you been employed by your current employer?

What shift do you work?

Education Level

Please list degree or certificate:

Are you currently attending school?

Has your driver's license been suspended or revoked in the past five years?

If yes, for what reason?

Have you been convicted of a misdemeanor crime in the past five years?

If yes, for what reason?

Have you been convicted of a felony in the past five years?

List References Below:

Reason for joining Beechwood Fire Department:

In filling out this application you are giving the Beechwood Volunteer Fire Department the permission to perform a background check and driver's license check before being accepted into membership. You are also agreeing to make every effort to become an Entry Level Certified Firefighter in this department within 24 months of joining. (Dependent upon class availability.)

Upon acceptance to the Beechwood Fire Department, you will be on a probationary status for six months. You also agree to follow, to the best of your ability, the SOG's and by-laws set forth by this organization.

You will be required to attend six meetings and six practices the first year to maintain membership in this organization.

Upon review by the officers of the Beechwood Fire Department and acceptance of the active membership, if for any reason your application is denied, you will be given the opportunity to reapply in one year.

If at any time you choose to terminate your membership to the department, or your membership is terminated through disciplinary actions, you agree to return all items (bunker gear, gloves, helmet, boots, pager, pager case, and charger) to the chief of the department.

In reading these terms and conditions, you fully understand and will comply with the rules and procedures of the Beechwood Fire Department. You also state and confirm that all information provided on this application is true to the best of your knowledge.

Signature

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