Newburgh Volunteer Fire Department Membership Pre-Application

This is a pre-application form for the position(s) of:

Volunteer Firefighter (Ages 18+ with High School Diploma/GED)
Cadet Volunteer Firefighter (Ages 15 - 18)
 

This application is the first step in seeking membership with the NVFD.  There are three (3) steps in gaining membership with the fire department.

1) Complete this pre-application in full.
2) If a vacancy is available, A membership committee member will contact you.
3) A more detailed application packet will be forwarded to you to complete.
4) Once your application packet is returned, an orientation will be scheduled.  
3) Firefighter Applicants will be voted on by the members of the department.
4) Cadet Firefighters will be brought on and referred to the Cadet Coordinators.

All applications are kept on file for six (6) months and are reviewed for all vacant positions for which an applicant is qualified. Newburgh Fire Department is always accepting applications.

The Newburgh Volunteer Firefighters, © Copyright 2010 All Rights Reserved.
 

Type of Application:

I am applying for the position of:
 
Pre-Application Information:

First Name and Middle Initial:   Last Name:

Primary Phone:   Secondary Phone: 

Street Address:
                City:        State:       ZIP:

Email address:

Date of Birth:
(Please indicate month/day/year)

Gender:  Male  Female

Social Security Number:
(Note: Your SSN is not retained on file and is only used in assisting with a criminal background check.)

Driver's License Number:
(Note: Please indicate state of issue, operator's license number, and month/year of expiration.)
State:  OLN #:  Month/Year Expiration:

Medical Questionnaire

Please read the following statements and determine if they apply to you.

  • Any physical handicaps or limitations.
  • Any serious illnesses or medical conditions in last five (5) years.
  • Any known allergies?
  • Any known reactions to medications?

Do any of the above apply to you?  Yes  No

Physical Condition / Medical / Allergy Explanation:
(If you answered "YES" to the above question, please explain here.)
   

Criminal Questionnaire

Please read the following statements and determine if they apply to you.

  • Previous felony or misdemeanor convictions.
  • Criminal actions currently pending.
  • Any convictions in last ten (10) years?
  • Any traffic or moving violations in the last three (3) three years that resulted in a citation/infraction?

Do any of the above apply to you?  Yes  No

Criminal Convictions / History / Traffic Infraction Explanation:
(If you answered "YES" to the above question, please explain here.)
   

 

 
 
 
I do hereby submit this pre-application seeking membership with the Newburgh Volunteer Fire Department as an active Firefighter or Cadet, to aid in the prevention and extinguishment of fires, to protect lives and property.

I certify that the facts in this application are true and complete to the best of my knowledge and I understand that, if employed as a Volunteer Firefighter, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained therein and the references and employers listed above to give any and all information concerning my previous employment and any pertinent information that may result from the utilization of such information.