HURRICANE CREEK VOLUNTEER FIRE DEPARTMENT

MEMBERSHIP APPLICATION
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                  HURRICANE CREEK VOL FIRE DEPT
                      APPLICATION FOR MEMBERSHIP
 
DATE-----/-----/-------
FULL NAME-------------------------------------------AGE---------HEIGHT-----------WEIGHT---
 
D.O.B-----------------------S.S.N---------------------------------SEX;MALE--------FEMALE----
 
HOME ADDRESS;-----------------------------------------MAILING ADDRESS----------------------------------------------------------------------------------------------------------------------------------------
 
CITY;-------------------------------------STATE---------HOME PHONE------------------------------
 
EMPLOYERS NAME------------------------------------------------WORK ADDRESS-----------
 
----------------------------------------------------------------------------------------------------------------------
 
CITY------------------------------------STATE----------------------
 
MARTIAL STATUS; SINGLE---------MARRIED-------------------DIVORCED-------------
 
IF YOU WAS PAGED OUT WHILE AT WORK WILL YOUR EMPLOYER LET YOU LEAVE WORK ?NO----------------YES------------------OTHER------------------------
 
DO YOU HAVE ANY PHYSICAL OR MENTAL HANDICAPS.PLEASE
 
EXPLAIN?-------------------------------------------------------------------------------------------------
 
HAVE YOU IN THE PAST 2 YEARS BEEN UNDER THE CARE OF A PHYSICIAN YES-------------NO---------------IF YOU ANSWERED YES TO ABOVE
QUESTION PLEASE STATE THE NATURE AND DURATION OF THE
 
ILLNESS--------------------------------------------------------------------------------------------------------
 
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LIST THE HIGHEST EDUCATIONAL LEVEL THAT YOU HAVE COMPLETED
 
GRADE SCHOOL------------HIGH SCHOOL-------------COLLEGE--------GED-------------
 
HAVE YOU EVER BEEN ON THIS DEPT BEFORE YES--------NO--------
 
IF YES PLEASE GIVE THE DATES IN WHICH YOU WERE ON------------------------
 
GIVE THE NAMES OF THREE PERSONAL REFERENCES NOT RELATED TO YOU
 
NAME--------------------------------------ADDRESS--------------------PH#----------------------------
 
NAME--------------------------------------ADDRESS--------------------PH#----------------------------
 
NAME--------------------------------------ADDRESS--------------------PH#----------------------------
 
PLEASE READ THE BYLAWS WITH THIS APPLICATION AFTER READING DO YOU AGREE TO ABIDE BY THEM TO THE BEST OF YOUR ABILITY
 
YES--------------NO---------------
 
ANY STATEMENT FALSIFIED BY AN APPLICANT ON THIS APPLICATION
WILL RESULT IN THE DISMISSAL OF THE APPLICANT IN THE FUTURE IF THEY ARE ACCEPTED AS A MEMBER
 
PLEASE EXPLAIN IN THE SPACE BELOW AS TO YOU REASON FOR WANTING TO BECOME A MEMBER OF THIS DEPARTMENT AND WHAT YOU EXPECT TO ACCOMPLISH--------------------------------------------------------------------
 
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IN SIGNING THIS APPLICATION YOU WILLINGLY GIVE YOUR PERMISSION FOR A COMPLETE BACK GROUND CHECK THROUGH NCIC NATIONAL CRIME INFORMATION CENTER AND POSSIBLE RANDOM DRUG TESTING
 
SIGNATURE---------------------------------------------DRIVERS LIC#---------------------------------

                                  REQUIREMENTS
1.APPLICANT MUST BE AT LEAST 18 YEARS OF AGE
2.APPLICANT MUST HAVE A VALID KY DRIVERS LICENSE
3.APPLICANT MUST HAVE A MOTOR VEHICLE
4.APPLICANT MUST BE OF GOOD MORAL CHARACTER
5.APPLICANT MUST NOT BE HABITUALLY ADDICTED TO OR AN ABUSER OF ALCOHOL DRUGS OR ANY CONTROLLED SUBSTANCES
6.APPLICANT MUST BE ABLE TO READ AND SPEAK WRITE AND UNDERSTAND THE ENGLISH LANGUAGE
7.APPLICANT MUST MAINTAIN THE REQUIRED TRAINING HOURS SET BY THE STATE OF KENTUCKY AND THIS DEPT
8.APPLICANT MUST BE IN GOOD HEALTH
9.NEW EQUIPMENT WILL GO TO THE MOST ACTIVE PERSONS WHEN NEW EQUIPMENT IS ISSUED TO ONE OR MORE PERSONS AT A TIME
10.APPLICANTS ARE ASK TO ATTEND ALL DRILLS AND MEETINGS
11.AFTER NEW EQUIPMENT IS ISSUED AND YOU SLACK ON RUNS AND DRILLS THE EQUIPMENT WILL BE UPON REQUEST TURNED IN
12.ALL NEW APPLICANTS WILL BE VOTED ON BY BOARD MEETING AT NEXT BUSINESS MEETING
13.IF A APPLICANT IS DENIED MEMBESHIP HE/SHE MUST WAIT AT LEAST SIX MONTHS BEFORE REAPPLYING
14.ALL MEMBERS ARE REQUIRED TO MAKE AS MANY RUNS AND TRAININGS AS POSSIBLE
15.ALL EQUIPMENT ISSUED MUST BE KEPT IN GOOD CONDITION IF YOU HAVE EQUIPMENT DAMAGED DUE TO FIRE DEPARTMENT RELATED INCIDENTS REPLACEMENT OR REPAIRS WILL BE MADE AT FIRE DEPTS EXPENSE OTHERWIZE ALL MAINTENANCE IS YOUR RESPONSIBILITY
16.ALL NEW FIREFIGHTERS MUST ACHIEVE THERE 25 HOURS OF TRINING WITH HCVFD BEFORE ANY GEAR WILL BE ISSUED TO THEM BY FIRE DEPT
17.NEW MEMBERS CAN NOT USE LIGHTS AND SIREN UNTILL THEY RECEVE REQUARD TRAINING AND HAVE PERMISHION FROM CHIEF