Full Application – Hightstown Engine Co No 1

Membership Application

Applicant Info

Membership Preference

Firefighter - must be a minimum of 18 years of age, must be resident of Hightstown or East Windsor for the six (6) months prior to acceptance and a citizen of the United States of America

Fire Police - must be at least 18 years of age

Associate Member - for those persons who express a desire to help the Company other than as an active Firefighter or Fire Police.

Junior Member - must be between 14 and 17 years of age

First Name

Last Name

Birthdate

Address

Address Line 1

City

State

Zip Code

Phone Number (Numbers ONLY, no hyphens, parentheses, or spaces)

Driver's License #

Has your driver's license ever been suspended?

Yes

Please explain

Do you have any special endorsements on your Driver’s License?

Bus

Articulated

Heavy Equipment

Other

Please enter Other endorsements

Have you ever been convicted of a crime?

Yes

Please state the circumstances

Place of Current Employment

Address

Address Line 1

City

State

Zip Code

How long been employed here?

Normal Work Schedule

Job Description

References

List three references (Non- Family Members) known for at least one year.

First Name

Last Name

Phone Number (Numbers ONLY, no hyphens, parentheses, or spaces)

Address

Address Line 1

City

State

Zip Code

First Name

Last Name

Phone Number (Numbers ONLY, no hyphens, parentheses, or spaces)

Address

Address Line 1

City

State

Zip Code

First Name

Last Name

Phone Number (Numbers ONLY, no hyphens, parentheses, or spaces)

Address

Address Line 1

City

State

Zip Code

Emergency Contact Information

In case of an emergency, who should we contact?

First Name

Last Name

Day Time Phone # (Numbers ONLY, no hyphens, parentheses, or spaces)

Night Time Phone # (Numbers ONLY, no hyphens, parentheses, or spaces)

Address

Address Line 1

City

State

Zip Code

Additional Info

List any hobbies or interests you have, Boating, Fishing, Hunting, Scuba Diving, etc.....

Are you an American Citizen?

Yes

Have you served in the armed forces?

Yes

What branch of service?

Specialized training?

Are you currently or have you been a member of another Fire Department?

Yes

Department name and dates of service

Reason for leaving

Is there any information that is not included on this application that you feel we should know about you before we investigate your application?

Do you have any concerns with the Hightstown Engine Company #1 Membership Committee, doing a background check on your history?

Yes

Please elaborate

Do you have any problems with random Drug-Alcohol Testing?

Yes

Please elaborate

In short paragraph, explain why you wish to become a member of the Hightstown Engine Company #1 and what you can do for the company and our community.