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IS THERE A FIRE IN YOU?

JOIN NOW

support our mission!

DONATE

Membership Application can be completed using the form below. Or a printable (PDF) version can be requested via an email sent to northlakefd@gmail.com with the words "application request" in the subject.

Printed applications can be mailed to:
North Lake Fire Department
PO Box 2
Mayville, NY 14757

General Information

First name

Last name

Are you at least sixteen (16) years of age?

YES

NO

Do you possess a valid NYS drivers license?

YES

NO

Do you have access to a vehicle to permit you to respond to the station?

YES

NO

Please select all of the positions for which you intend to become qualified and perform:

Interior Firefighter

Exterior Firefighter

EMT

Fire Police

Other

Address Information:

Residence Address

Country/Region

Address

City

Zip / Postal code

Mailing Address

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

How long have you lived at your present address?

Years

Months

If less than 2 years, please include your prior addresses for the last two years:

Do you intend to reside in the fire department's fire protection area for the next few years?

YES

NO

If no, please explain why not? (college, etc)

Employment Information

Company name

Address

Position

Start Date

End Date

Education and Past Fire Department Service

List any relevant certifications, courses, trainings (please include any expiration dates, if applicable):

What is your highest grade/level of education completed?

High School /GED

College Degree

Other

Have you previously belonged to another fire department or ambulance service?

YES

NO

If yes, please provide department name, address, and years of service.

Citizen Status

Are you a citizen of the United States?

YES

NO

If not, do you intend to become a citizen of the United States?

YES

NO

If not, do you have the legal right to remain permanently in the United States?

YES

NO

Do you intend to remain permanently in the United States?

YES

NO

Past Criminal History

Have you ever been convicted or plead to a criminal offence?

YES

NO

If yes, provide offense convicted of:

Date of conviction:

Month

Day

Year

How long ago was the conviction?

Has a certificate of relief from disabilities been obtained?

YES

NO

Have you ever been convicted of either of the following types of offenses?

Arson or attempted arson in any degree

YES

NO

An offense requiring registration as a sex offender

YES

NO

Do you have any pending arrests?

YES

NO

Physical Ability

Can you perform the functions of at leas tone of the positions in which you are interested, with or without reasonable accomodation? *

YES

NO

(Please see the attached list of physical requirements)

*The Fire Department reserves the right to determine what is reasonable.

Personal References

Please provide three (3) individuals who will share information regarding your potential service as a member of the fire department:

Reference 1

Name:

Address:

Phone:

Reference 2

Name:

Address:

Phone:

Reference 3

Name:

Address:

Phone:

Applicant Signature:

I hereby attest that the above answers are true to the best of my knowledge and may be relied upon in consideration of my application.

Printed Name

I, the above signed applicant, hereby consent to a criminal background check and to review of my information as may be publicly posted on social media. I understand that this information will be utilized in the review of legal grounds for consideration of membership only, but could result in denial of membership for legal reasons only.

Signature

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Signature field is empty.

Agreement for Background Check

Signature:

Sign in the box or use the keyboard to type.

Signature field is empty.

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IS THERE A FIRE IN YOU?

support our mission!

Membership Application can be completed using the form below. Or a printable (PDF) version can be requested via an email sent to northlakefd@gmail.com with the words "application request" in the subject. Printed applications can be mailed to: North Lake Fire Department PO Box 2 Mayville, NY 14757

General Information

Address Information:

Employment Information

Education and Past Fire Department Service

Citizen Status

Past Criminal History

Physical Ability

Personal References

Applicant Signature:

Agreement for Background Check

Membership Application can be completed using the form below. Or a printable (PDF) version can be requested via an email sent to northlakefd@gmail.com with the words "application request" in the subject.

Printed applications can be mailed to:
North Lake Fire Department
PO Box 2
Mayville, NY 14757