APPLICATION FOR MEMBERSHIP

Thank you for your interest in becoming an Echo Hose Firefighter! Don’t be scared away by our lengthily application as its a short period of your time for a lifetime of opportunity. Be sure to fill out as much information as possible. Anything marked with a * is a mandatory field. All information is kept confidential. Once your application has been successfully submitted you will be contacted by one of our company officers after a full review of your application.

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First
Middle
Last
Address
City
State
Zip
Home Phone
Cell Phone
Birthday
Social Security Number
Are you a citizen of the United States
If no, are you authorized to work in the U.S.?
Have you ever worked for this company?
Have you ever been convicted of a felony?
If yes please explain:
0 /
Have you ever been arrested?true
If yes please explain:
0 /
Education
High SchoolName
AddressCity & State Also
FromYear
ToYear
Did you graduate?
Diploma?
CollegeName
AddressCity & State Also
FromYear
ToYear
Did you graduate?
Diploma?
OtherName
AddressCity & State Also
FromYear
ToYear
Did you graduate?
Diploma?
Please list three professional references
Reference One
Nametrue
Relationshiptrue
Companytrue
Phone Numbertrue
Addresstrue
Reference Two
Nametrue
Relationshiptrue
Companytrue
Phone Numbertrue
Addresstrue
Reference Three
Nametrue
Relationshiptrue
Companytrue
Phone Numbertrue
Addresstrue
Previous Employment
Company
Phone Number
Address
Supervisor
Job Title
Responsibilities
ToDate
FromDate
Reasonfor leaving
May we contact your previous supervisorfor a reference?
Previous Emergency Services
Have you or are you affiliated with another fire department or ems service?
Company
Phone Number
Address
Supervisor
Job Title
Responsibilities
ToDate
FromDate
Reasonfor leaving
May we contact your previous supervisorfor a reference?
Military Service
Have you ever served in any armed forces?
Branchof service
ToDate
FromDate
Rankat discharge
Typeof discharge
If other then honorable,please explain
Final Section
Please explain why you want to become a member of the Echo Hosetrue
0 /
Disclaimer and Signature
I have read this application and answered all questions set forth in this application correctly and true to the best of my knowledge. I certify that the information is true and complete to the best of my knowledge. I understand that any willful omissions or falsification will be reason for dismissal of my application, or termination from the department when and if an omission and falsehood is discovered. I promise and agree that if accepted I will conform to the Constitution and By-Laws of the selective Fire Company of the Shelton Fire Department. I further promise to pay all fines and dues legally imposed and to attend all drills, meetings, parades and events as far as lies within my power. All of this I promise my sacred honor.
Digital SignatureFirst, Middle & Last Name
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