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Application for Membership
Wallkill Hook, Ladder and Hose Co., Inc.
112 Bona Ventura Ave.
Wallkill, NY 12589
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Email
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Name
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First and Last name
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Phone number
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Street Address
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Zip code
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How long have you lived at this address?
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Which position(s) are you interested in?
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Firefighter
Social Member
Auxiliary
Not sure, but I want to help.
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Firefighter
Social Member
Auxiliary
Not sure, but I want to help.
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Please list any previous emergency service experience. Include name of Agency and contact person
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Do you have a Valid Drivers License?
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If yes, please enter Drivers License number.
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Have you ever been a member of the Armed Forces
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If the answer is "Yes" did you receive a dishonorable discharge?
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Have you ever been convicted or plead guilty to a felony of Arson?
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OSHA regulations require that you pass a physical examination before becoming an interior structural firefighter. The department's designated physicians will provide you with a free medical examination. Will you be willing to undergo a medical examination?
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Emergency Contact name and phone number
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If currently employed, please provide employer Name, Address, phone number and contact person
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May we contact your employer as a reference?
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Are you able to participate in normally required fire department activities? Normal activities are Monthly Meetings, weekly drill/training and emergency calls.
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