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Vigilant Engine & Hook & Ladder Co., Inc.

VOLUNTEER

VOLUNTEER APPLICATION

Thank you for your interest in volunteering with Vigilant! Please fill out and submit the application document.

We will get back to you as soon as possible!

Volunteer with Vigilant!

First Name

Last Name

Email

Cell Phone

How did you find out about us?

Which days are you available?

Mon

Tue

Wed

Thu

Fri

Sat

A few words about you

Address

Home Phone

Office Phone

Place of Birth

Birthday

List All Addresses (other than current address) that you have resided at over the past six years:

Are you a U.S. Citizen?

Yes

No

If no, what is your current status in the U.S. (provide proof)?

Do you have a New York State Driver License?

Yes

No

If yes, provide Driver ID Number:

Do you have daily access to a motor vehicle?

Yes

No

Are you available to respond to fire/ambulance calls from: 10PM until 6AM?

Yes

No

6AM until 2PM?

Yes

No

2PM until 10PM?

Yes

No

Weekends?

Yes

No

Company (if employed)

Length of Employment

Work Address

Position

Work Hours

School Name

Anticipated Graduation Date

Course of Study/Major

School hours

Prior First Responder Membership: Have you ever been a member of any fire department or Ambulance Company? (If yes, please fill out the next 8 fields as well.)

Yes

No

Department name

Department address

Department phone number

Commanding officer name and contact information

Dates of Membership

Offices held, if any

First Responder Certifications, if any

Reason for leaving prior department

Prior Criminal History: Have you ever been convicted of, or plead guilty to, a crime or violation, including violations of the Vehicle and Traffic Law?

Yes

No

If Yes, list all dates of convictions - please include the specific penal law section, statute, or Vehicle and Traffic Law Section you were found to have violated, including the court that issued the decision as well as the index/docket number:

Are you currently involved in any pending litigation in any court in the state of New York (including criminal matters)?

Yes

No

If Yes, please describe these pending matters in detail, including the Court name, your involvement in the matter and the docket or index number(s):

If you know any members of Vigilant, please list their names below:

I HEREBY SWEAR/ AFFIRM/ ATTEST THAT THE INFORMAITON PROVIDED HEREIN IS TRUE AND ACCURATE. (Type your name here.)

I HEREBY SWEAR/ AFFIRM/ ATTEST THAT THE INFORMAITON PROVIDED HEREIN IS TRUE AND ACCURATE. (Sign your name with mouse, finger, etc.)

If under 18 years of age, your parent or legal guardian must complete below:

Name

Relationship to applicant

Address

Home phone

Cell phone

Work phone

I HEREBY REPRESENT THAT I GIVE MY PERMISSION FOR THE APPLICANT TO BECOME AN ACTIVE MEMBER OF THE GREAT NECK VIGILANT ENGINE HOOK AND LADDER CO. INC. AND I AFFIRM/ATTEST/SWEAR THAT THE INFROMATION PROVIDED IN THIS APPLICATION IS TRUE AND ACCURATE. (Type your name.)

SIGNATURE OF PARENT OR LEGAL GUARDIAN. (Sign your name with mouse, finger, etc.)

Date

Thanks for applying to volunteer with us! We'll get back to you soon.

Vigilant Engine & Hook & Ladder Co., Inc.

(516) 487-1086

Emergency: 516-482-5000

info@gnfd.org

VOLUNTEER

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