Application for Membership

  • May inquiry be made of your present employer regarding your character and
    qualifications for membership?
  • Any special skills you possess (electrician, plumber, carpenter, etc.)?
  • If available, would you be able to attend the NYS fire training program?
  • Would you attend drills if available?
  • Have you any physical handicap, chronic disease or any other disabilities?
  • Would you be willing to take a physical exam?
  • Has your driver’s license ever been suspended or revoked?
  • Have you ever been convicted of a crime other than a traffic infraction?
  • Is there any other organization you belong to?
  • Have you had any previous firefighting training?
  • Have you ever attended NYS fire training school?
  • What certificates do you hold?
  • Graduate courses such, as pump operator, arson, etc.
  • Have you ever belonged to any other fire department?

List three persons who are not related to you and who have definite knowledge of your qualifications for membership:

A copy of your driver’s license must be provided upon submission of the application

I, , herby make application for membership in the Kiryas Joel Fire Department, Monroe, New York.

I understand the responsibility of this organization to the members and the community that if accepted, I shall abide by the by-laws and policies of the Kiryas Joel Fire Department under the direction of the duly elected or appointed officers of the organization. I also agree that all KJFD keys, portable radios, car emblems, and/or items loaned, are to be returned immediately on demand. I will consider as confidential, all information that I may hear directly or indirectly, considering a fire issue. I further agree to act in the name of the KJFD only as authorized by the officers or directors.

All requested information must be furnished. The information you give will be used to determine your qualification for membership.

A false or dishonest answer to any question may be grounds for rating you ineligible for membership in the Kiryas Joel Fire Department, or for expelling you after being elected into the membership. All information will be considered in determine your application for membership.

I certify that all of the statements made in this application are true, complete and correct to the best of my knowledge and belief and are made in good faith.

All questions answered on this application will be in strict
confidence of the investigating committee only.

Action Date
Membership committee review:  
General membership approval:  
Probationary membership approval:  
Active squad membership approval: