Ladies Auxiliary - Junior Fire Company

Date

10/28/2026 1959

Name

Last, First, Middle

Address

Street, City, State, Zip Code

Home Phone Number

Cell Phone Number

Email Address Required

Do you belong to any other auxiliary, fire or rescue company Required

Yes No

Preffered method of communication Required

Select all that apply

Cell Phone Home Phone Email

Electronic Signature Required

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.