Volunteer Firefighter - Membership Application - New Hartford Fire Department

Are you 18 years of age or older?*

Yes

You must be 18 years of age or older to apply to be a volunteer firefighter with the New Hartford Fire Department.

However, if you are between the ages of 16-17, we invite you to check out our Restricted Member Program.

Name*

First Name: Middle Initial: Last Name:

Address*

Street Address: Address Line 2: City: State: Zip:

Email:*

Phone:*

How long have you lived at the above address?

How long have you resided in New York State?

Is additional information about a change in your name or your use of an assumed name or nickname necessary to enable a check on your eligibility for membership?*

Yes

Please explain:*

Please list three personal references, other than members of this organization, who have known you at least three (3) years:

Reference 1

REFERENCE #1:

First Name: Last Name:

Address

Street Address Address Line 2 City State ZIP Code

Phone

Reference 2

REFERENCE #2:

First Name: Last Name:

Address

Street Address Address Line 2 City State ZIP Code

Phone

Reference 3

REFERENCE #3:

First Name: Last Name:

Address

Street Address Address Line 2 City State ZIP Code

Phone:

Volunteer Firefighter – Membership Application

Please complete the entire membership application below. Incomplete applications will not be considered.

Reference 1

Reference 2

Reference 3

Applicant’s Authorization for Release of Information

New Hartford Fire Department

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