Cazenovia Fire Department

Application for Membership

Last Name: *

First Name: *

M.I *

Email Address *

Hometown Address, PO Box, Street, City, State, Zip Code *

College Address, PO Box, Street, City, State, Zip Code

Primary Phone Number *

Home

Cell

How long have you resided at the above address? *

How long have you lived in New York State? *

Age: *

Birth Date *

S.S.N. *

Sex *

Male

Female

Are you a citizen of the US *

Yes

If not, do you have the right to permanently remain in the US? *

Yes

Do you posses a current NYS Drivers Licence? *

Yes

Drivers Licence Class *

Drivers Licence ID # *

Exp. Date *

Have you ever been a member of any other Fire Department? *

Yes

Department

Roles

Have you ever been known by any other names?
(if yes please list names(s) (Necessary for arson check form)

Yes

Have you ever been convicted of the crime of Arson?
(Every applicant will be subject to an arson backround check) *

Yes

If yes, please explain

Have you ever been convicted of a misdemeanor or felony crime other than a case in which you were granted youthful offender status or the file was otherwise sealed? *

Yes

Please list current Employer

Employer *

Address *

Position *

In case of emergency contacts *

Report abuse