Are you at least sixteen (16) years of age?
Do you possess a valid NYS drivers license?
Do you have access to a vehicle to permit you to respond to the station?
Please select all of the positions for which you intend to become qualified and perform:
How long have you lived at your present address?
If less than 2 years, please include your prior addresses for the last two years:
Do you intend to reside in the fire department's fire protection area for the next few years?
If no, please explain why not? (college, etc)
Education and Past Fire Department Service List any relevant certifications, courses, trainings (please include any expiration dates, if applicable):
What is your highest grade/level of education completed?
Have you previously belonged to another fire department or ambulance service?
If yes, please provide department name, address, and years of service.
Are you a citizen of the United States?
If not, do you intend to become a citizen of the United States?
If not, do you have the legal right to remain permanently in the United States?
Do you intend to remain permanently in the United States?
Have you ever been convicted or plead to a criminal offence?
If yes, provide offense convicted of:
How long ago was the conviction?
Has a certificate of relief from disabilities been obtained?
Have you ever been convicted of either of the following types of offenses?
Arson or attempted arson in any degree
An offense requiring registration as a sex offender
Do you have any pending arrests?
Can you perform the functions of at leas tone of the positions in which you are interested, with or without reasonable accomodation? *
(Please see the attached list of physical requirements)
*The Fire Department reserves the right to determine what is reasonable.
Please provide three (3) individuals who will share information regarding your potential service as a member of the fire department:
I hereby attest that the above answers are true to the best of my knowledge and may be relied upon in consideration of my application.
I, the above signed applicant, hereby consent to a criminal background check and to review of my information as may be publicly posted on social media. I understand that this information will be utilized in the review of legal grounds for consideration of membership only, but could result in denial of membership for legal reasons only.
Agreement for Background Check 