Barnegat Fire Company No.1 Ocean County Station 11

Barnegat Fire Company No.1 Ocean County Station 11 Membership Application Packet

Barnegat Volunteer Fire Company No.1 Station 11 11 Birdsall Street Barnegat, New Jersey 08005 609-698-6766 www.station11.org

Dear Applicant: Thank you for your interest in becoming a member of Barnegat Fire Company No.1, Station 11. Our success as an emergency response department depends on knowledgeable, educated, and dependable people who are willing to give time and effort to accomplish a common goal. The process of becoming a member of the Barnegat Fire Company is straightforward, and it starts with completing the attached membership application in its entirety. Include all names, telephone numbers, addresses, etc.; do not leave sections blank. Once you have completed the application in its entirety, you need to make arrangements for an in person meeting with a member of the Recruitment and Retention Division listed below to submit your application. Do not drop off or leave your completed application at the firehouse. Applications that are left at the firehouse will not be accepted or considered for membership. A valid New Jersey driver’s license with a Barnegat address must be presented along with your application. After the completion of this step you will sit for a board interview with the Recruitment and Retention Division, the President of the Fire Company, and the Chief of the Department. Board interviews are held on the third Tuesday of each month. The final phase of the application process requires that you:    

Complete a physical examination, and pass a drug test. Complete and submit an application for membership to the New Jersey State Firemen’s Association. Pass a criminal background check conducted by the Barnegat Township Police Department. Be voted on and approved by the Barnegat Township Committee.

Members of the Recruitment and Retention Division will assist you in navigating all the steps required for membership. Thank you again for your interest in joining Barnegat Fire Company No.1, Station 11. Andy Watts Recruitment and Retention 404-538-3539

Scott Sircovitch Recruitment and Retention 908-675-5120

Attention: Recruitment Division Barnegat Fire Company No.1 Attached is my application for membership with the Barnegat Fire Company. I have given my full name, address, and other pertinent information as requested. I understand that this application must be completed in its entirety to receive consideration for membership. I certify that I have carefully completed this application, and that I have given all information herein without omission or falsification. I further attest that no information has been withheld about my background. I certify that I am least eighteen years of age; a legal resident of the United States; a resident of Barnegat Township, New Jersey; hold a current New Jersey drivers’ license; have a social security number; and have a high school diploma or GED equivalent. By signing my name to this letter I consent to the investigation of all facts and circumstances given in the attached application for membership to the Barnegat Fire Company. I also consent to the interview of any references provided herein, and to any background investigation needed by any law enforcement agency. I fully understand that should any information herein be investigated and found to be false, I will be subject to dismissal from the Barnegat Fire Company without recourse. By signing below, I also agree that should I become a member of the Barnegat Fire Company, it is my responsibility to obtain copies of all governing by-laws and policies. It is my responsibility to comply with these by-laws and policies. I understand that if I fail to comply with these by-laws and policies, I may face disciplinary actions and /or termination of my membership from the company.

___________________________ Applicant Signature

______________________ Date of Application

Barnegat Fire Company No.1 Membership Application Personal Information _____________________ Last Name

________________________ First Name

________________________ Middle Name

__________________________________________________ Address __________________________________________________ City/State Zip Code _____________________ Home Phone

_______________________ Cell Phone

_____________________ Driver’s License #

_______________________ Driver’s License Class

_____________________ Date of Birth

________________________ Place of Birth

US Citizen Yes_____

___________________________________________________ E-Mail Address

No_____

_________________________ Work Phone

_________________________ Social Security #

Military Service _____________________ Branch

________________________ Date of Service

_______________________________ Rank and Discharge Status

Employment History __________________________________ Current Employer

________________________________________ Position Held

________________________________________________________________________________ Employer Address __________________ ________________ City State

___________ Zip

___________________________ How Long With Current Employer

Education (Highest Level Attained Only)

________________________ Institution Name

___________ State

_________________________ _______________ Date of Attendance Did You Graduate?

___________________________________________________ If you did not graduate from high school, did you attain a GED?

Firefighting Experience and Training Have you previously been a member of a Fire Company? If yes, list department below. Yes_____ No_____ _______________________ Department Name

_______________________________ ______________ Street Address, City, State, Zip Length of Service

Have you ever applied for membership with the Barnegat Fire Company? Yes_____ No_____

Are you a certified firefighter? Yes_____ No_____

Level __________________

Date Received ______________

Are you a certified instructor? Yes_____ No_____

Level __________________

Date Received ______________

Have you ever attended a Fire Academy? If yes, please provide name, address, and date of attendance. Yes_____ No_____ Date of Attendance_____________ ___________________________________________________________________ Name ___________________________________________________________________ Address State County Zip

References List any members of the Barnegat Fire Company with whom you are acquainted. _______________________________ ______________________________ Name Phone _______________________________ ______________________________ Name Phone _______________________________ ______________________________ Name Phone

List three (3) references, other than relatives and others named above. ________________________ Name

_________________________ ____________ _____________ Address Phone Relationship

________________________ Name

_________________________ ____________ _____________ Address Phone Relationship

________________________ Name

_________________________ ____________ _____________ Address Phone Relationship

Emergency Contact Information ________________________ Name

_________________________ ____________ _____________ Address Phone Relationship

Medical Information You will be required to pass a physical examination by a licensed physician prior to acceptance into the Barnegat Fire Company. You will also be required to pass a drug test administered by a licensed testing facility chosen by Barnegat Township.

How Did You Hear About Us? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Why do you want to become a member of the Barnegat Fire Company? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Statement of Veracity (Review your answers carefully and read the statement below before signing) I represent and warrant that the answers I have given are complete and true to the best of my knowledge and belief. I understand that failure to answer all questions completely and sincerely will disqualify me for membership with the Barnegat Volunteer Fire Company.

______________________________ Applicant Signature

__________________________ Date Signed

For Office Use Only _____________________ Date Received

______________________ Date of Next FF1

______________________________ Date Contacted for OCFA Enrollment

_____________________ Background Check

______________________ Medical Exam

______________________________ Township Approval

_________________________________ Approved for Probationary Membership