Join Us – West Hurley Fire

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Member Application

WHFD

Join WHFD

To apply, fill the form to the right, or contact us using the information below:

Call 845.679.2013.

whfd.deptsecretary@gmail.com

PO BOX 302, West Hurley, NY 12491

24 Wall St., West Hurley, NY 12491

You may also download the PDF application form below, fill it out, and send it back to us at whfd.deptsecretary@gmail.com.

Download Application Form

"*" indicates required fields

Step 1 of 3 - Personal Information

33%

NAME*

EMAIL*

TELEPHONE #*

STREET*

CITY*

STATE*

ZIP*

AGE*

DATE OF BIRTH*

MM slash DD slash YYYY

DRIVERS LICENSE #*

EMERGENCY CONTACT*

TELEPHONE #*

PRESENT EMPLOYMENT*

REFERENCES
MUST LIST 3 REFERENCES, AND PLEASE NOTE THAT REFERENCE WILL BE CHECKED PRIOR TO MEMBERSHIP APPROVAL

NAME*

ADDRESS*

TELEPHONE #*

NAME*

ADDRESS*

TELEPHONE #*

NAME*

ADDRESS*

TELEPHONE #*

GENERAL

ALLERGIES*

AREAS OF INTEREST*

FIREFIGHTER (INTERIOR/EXTERIOR)

EMS

DRIVER

FIRE POLICE

AUXILIARY

HAVE YOU EVER BEEN CONVICTED OF ARSON IN ANY DEGREE?*

YES

HAVE YOU EVER BELONGED TO ANOTHER FIRE DEPARTMENT?*

YES

IF YES, WHEN AND WHERE*

ARE YOU CURRENTLY A MEMBER OF ANOTHER FIRE DEPARTMENT?*

YES

HAVE YOU EVER COMPLETED ANY OFPC FIRE OF DOH EMS TRAINING?*

YES

ANY OTHER CERTIFICATIONS, LICENSES, QUALIFICATIONS THAT YOU’D LIKE TO SHARE WITH US:*

WHY ARE YOU INTERESTED IN JOINING OUR FIRE DEPARTMENT?*

PLEASE PROVIDE ANY/ALL PREVIOUS TRAININGS CERTIFICATES TO THE DEPARTMENT SECRETARY

I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE.

SIGNATURE OF APPLICANT*

WHFD

The West Hurley Fire Department, located in West Hurley, NY, provides fire protection and emergency response services to the West Hurley community.

For emergencies call
911

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