Name (Last, First, Middle)
Year of birth
Cell phone #
Cell phone carrier (AT&T, Verizon, Sprint…)
Home phone #
Email address
Current home address
City, State and Zip code
How many years living at the above address?
How many years living in New York State?

Highest level of education completed (High school, college…)

Current employer name
Current employer address
Employer phone
Job title
How long have you worked there?

Name of reference 1
Address
City, State and Zip code
Phone
Relationship
Name of reference 2
Address
City, State and Zip code
Phone
Relationship

Do you know any members of the LBFD?YESNO
If YES, name of current or former member(s)

What is your reason for joining the LBFD?
Have you ever served as a volunteer or career firefighter or EMT?YESNO
If YES, please provide additional details
Have you ever served as a volunteer in any organization?YESNO
If YES, please provide additional details
Do you have a license to practice a trade or profession?YESNO
If YES, please explain
Do you have any certifications? (Lifeguard, Fire classes, CPR, …) YESNO
If YES, please explain
Have you ever served in the United States Military? YESNO
If YES, please provide additional details
Have you ever been convicted of a misdemeanor or felony? YESNO
If YES, please explain
Have you ever been dismissed from public employment? YESNO
If YES, please explain

Type your full name
Provide your signature

Long Beach Volunteer Fire Department
Code of Ethics

1. I fully realize and accept the responsibilities of being a Volunteer Firefighter and shall perform the duties assigned to me.

2. I shall respond promptly to all alarms of fire.

3. I shall do my share of work required to maintain apparatus, equipment, and the fire houses.

4. I shall report to the fire house immediately after each call in order to help put apparatus and equipment in shape for the next call.

5. I shall refrain from using profane or immoral language while working at fires and in or around the firehouse.

6. I shall do my work at fires or drills in a quick and orderly manner.

7. I shall report for drills, practice earnestly, and do my part in making our Fire Department an efficient, orderly fire-fighting organization.

8. I shall be loyal to my Officers and Department and shall conduct myself at all times in a manner that is in keeping with the responsibilities of a firefighter.

9. I shall remember that I am in the eyes of the public both on and off duty, and I shall conduct myself accordingly.

10. If at any time I feel that I cannot comply with the Rules and Regulations of the Long Beach Fire Department, I shall voluntarily resign.

This application will be investigated by the Department Membership Board and its findings will be submitted to the Board of Fire Commissioners. This application will also be checked by local law enforcement agencies before you will be allowed to become a member of this department. All information will remain confidential.

DECLARATION BY APPLICANT

I affirm, subject to the penalties for perjury, that the statements by me contained herein on this application are to the best of my knowledge and belief, true and correct.

ANY FALSE STATEMENTS MADE IN THIS APPLICATION IS PUNISHABLE AS A CLASS A MISDEMEANOR PUSUANT TO SECTION 210.45 OF THE NEW YORK STATE PENAL LAW.

Provide your signature