East Limestone Volunteer Fire Department

Membership Application

 

Name: ________________________________________________

Address: ______________________________________________

Telephone: ­­­­­­­­____________________________________________

Date of Birth: __________________________________________

State Driver’s License #: _______________     Social Security #: ________________________

Directions to Your Home: _______________________________________________________

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Employer: __________________________    Hours You Work: _________________________

What hours will you be available for call to runs? _____________________________________

List any special skills you possess: _________________________________________________

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Have you had any previous fire fighting experience? If yes, where? _______________________

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Have you had any EMS training?  B, I, P, or 1^st responder.  If yes, License #: _______________

Do you have any disability that would prohibit you from fighting fires? ____________________

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Have you read and understood the charter, bylaws, and equipment agreement?  If so are you willing to abide by them? _________________________________________________________

 

 

I ________________________ by this application to the East Limestone Volunteer Fire Department do hereby  agree to follow the rules and regulations set forth in the charter, bylaws, and equipment agreement.  If accepted as an active member of the fire department.

Signed: _____________________________

Date: _____________________________

 

Accepted into membership on _________________ 20 ______

Presidents Signature: _________________________________