| Membership Type:
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| Area of Interest:
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| Name:
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| Street Address:
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| City, State, Zip Code:
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| How long have you lived at this address:
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| Email Address:
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| Home Phone Number:
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| Cell Phone Number:
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| Date of Birth:
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| Social Security Number:
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| Driver’s License Number:
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| Driver’s License State Issued:
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| Employer Name:
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| Work Phone Number:
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| Employer Address:
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| Occupation:
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| Have you ever been convicted of any violation of the law, other than minor traffic violations:
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| If Have you ever been convicted of any violation of the law, other than minor traffic violations please explain:
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| Your physical condition (please note any impairments):
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| Have you ever made application or been a member of another fire department:
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| If you have been a member of another department, where:
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| If you were a member of another fire department, specify type:
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Paid
Volunteer
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HoCo EID #:
(If Applicable)
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| Provide three character references not related to you |
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Reference #1:
Name, Address, Phone Number, Relationship
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Reference #2:
Name, Address, Phone Number, Relationship
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Reference #3:
Name, Address, Phone Number, Relationship
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| Please Submit copy of your Drivers License and Social Security Card (Under 18 please also submit work permit):
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| If elected to membership, I will support the Constitution, adhere to the Bylaws, and obey all rules and regulations of the WFVFD. |
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| I will also avail myself of the necessary FIRE/EMS training courses to become a fully competent member. Once I am able to ride apparatus, I acknowledge that I will be expected to participate on a duty crew. |
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| I also acknowledge that all statements made in this application are true and correct to the best of my knowledge, and I approve the use of the information provided in this application to conduct a complete background investigation. |
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| Electronic Signature of Applicant:
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| Signature of Parent or Guardian (If Applicant Is Under 18):
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| Submitted:
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07/27/2024 0637 |
