Thank you for considering membership with the Junior Fire Company. The completed membership application along with annual dues should be returned to the fire company upon completion.

Upon receipt if your completed application, you understand that as part of our probationary membership, an investigation will take place. A criminal background check will be completed in addition to reference checks. During the investigation process you will be interviewed by a member or members of the investigation committee. The information obtained during the interview process will be managed with strict confidence. You can contact a member of the investigating committee at any time to check the status of your application. If the results of your investigation and interview are favorable a member of the investigating committee will contact you about an orientation meeting and introduction to membership at a regular company meeting. You must be present at the meeting to be voted into the company. Meetings take place in January, March, May, July, September and November.

After your orientation meeting you will be presented to the fire company for approval, once approved, you will be on a probationary member for a period of one year from acceptance into the organization. Please note that your application for membership can be rejected at the company meeting. During your first year you will be required to maintain a certain level of activity, acquire training and complete a physical examination. Details about these requirements will be outlined for you in your orientation meeting with the Investigation Committee.

We welcome you to the opportunity to protect the lives and property of our community as part of the Junior Fire Company.

It is the responsibility of the application to provide the following information as part of this application:

1. The sum of one year of annual dues.
2. Copies of all fire, rescue and medical related training documentation.
3. Copies of licensure and certifications to be considered in the evaluation for membership.
4. A copy of your driver’s license or state issued identification card

We can assist with copies of these documents if needed.

Please complete all sections of the application. Dues can be paid to any volunteer or career staff member at the station. Junior members have addition sections that must be completed and turned in as part of this application.

Indicates Required Field

Applicant Name:
Date of Application:		10/11/2024 1409
Section 1: Membership Status and Annual Dues
Please check the appropriate membership in which you are applying:		Senior Member (18 years of age and up) Junior Member (16 and 17 years of age) Administrative Member (16 years of age and up)
Annual Dues: Dues are $5.00 for all members 18 years and older. Dues for membership applications between the ages of 16 and 17 are free.
Section 2: Personnel Information
Name: Last, First, Middle
Nickname or preferred name:
Date of Birth:
Age:
Are you a citizen of the United States:		Select Below Yes No
If no, do you have the legal right to remain permanently in the United States:		Select Below Yes No
Address: Street, City, State, Zip, County
Length of time at current residence:
Phone # (mobile preferred):
Email:
Have you ever been a member of the Junior Fire Company:		Select Below Yes No
If yes, please detail:
Are you now or have you ever been a member of another fire, rescue or EMS organization:		Select Below Yes No
If you answered yes above, please detail:
Do you now or have you ever held any fire, rescue or medical certifications or licensure:		Select Below Yes No
If you have fire, rescue or medical certifications please list below:
Have any of the above certifications ever been suspended or revoked:		Select Below Yes No
If your certifications ever been suspended or revoked, please explain below:
Are there any skills or experiences you possess that would be beneficial to the organization:		Select Below Yes No
Please list the skills or experiences you possess that would be beneficial to the organization:
Section 3: Emergency Contact Information
Emergency Contact Name:
Emergency Contact Relationship:
Emergency Contact Phone Number:
Section 4: Criminal Background
Do you have any significant traffic convictions:		Select Below Yes No
Please list any significant traffic convictions below:
Have you ever been convicted of a crime:		Select Below Yes No
Please explain in detail any history of convicted crimes:
Section 5: Military Experience
Are you currently serving in the US Military:		Select Below Yes No
Have you ever served in the US Military:		Select Below Yes No
If yes, dates of service:
Rank:
MOS:
Branch:
Type of discharge:
Discharge date:
Section 6: Education History
Please list the highest level of education you have completed:
College #1:
Date Graduated College #1:
College #2:
Date Graduated College #2:
Trade School:
Date Graduated Trade School:
Are you currently in School (college/high school):		Select Below Yes No
Are you currently enrolled in a High School Fire/EMS program:		Select Below Yes No
Have you taken a high school Fire/EMS program:		Select Below Yes No
Grade level or college status:
High School:
Year Graduated or GED received:
High School Address:
Section 7: Employment History
Please list the most recent employer first, then go backward in chronological order. Please include volunteer experience.
Company #1:
Company #1 Address:
Company #1 Phone Number:
Company #1 Supervisor:
Company #1 Job Title:
Can we contact Company #1 for a reference:		Select Below Yes No
Company #2:
Company #2 Address:
Company #2 Phone Number:
Company #2 Supervisor:
Company #2 Job Title:
Can we contact Company #2 for a reference:		Select Below Yes No
Section 8: References
Please give the names of three people not related to you, that you have known for at least one year that we may contact as a reference.
Reference #1 Name:
Reference #1 Address:
Reference #1 Phone:
Reference #1 Years Acquainted:
Reference #1 How Acquainted:
Reference #2:
Reference #2 Address:
Reference #2 Phone:
Reference #2 Years Acquainted:
Reference #2 How Acquainted:
Section 9: Certification and Authorization
Electronic Signature of Applicant:
Signature of Parent or Legal Guardian (Junior members only):
I hereby certify that the statements contained herein are true and correct to the best of my knowledge. I understand should an investigation disclose misrepresentation, omissions or falsifications, my application may be rejected. My signature indicates that I understand that a job of a firefighter and/or EMT provider is physically challenging and my membership as an operational member is dependent upon successful completion of a medical examination, as well as successful completion of minimum training requirements. Administrative members are not required to complete a medical evaluation. I agree to abide by the By-Laws, rules and regulations of the Junior Fire Company No. 2, Inc. I acknowledge understanding those provisions outlined in this application.