I desire to become a member of the Ridge Fire Company. (Please Print)


Name:_________________________ Age:____


Address:_______________________________ Home Phone Number:(____)____-_______


City:_________________ State:___ Zip:________-____(Plus 4 if known)


State of Birth:______ Date of Birth:___/___/_____ Social Security#:_____-____-_______


Drivers License Number and State:______________ _____


Occupation:___________________________ Work Phone Number:(____)____-_______


Do you wish to be; Active:____ Social:____ Fire Police:____


Have you had previous Fire/Rescue/Ambulance service or training? Yes:____ No:____


If yes to above please list previous department(s), training, and certificate(s). Use separate page if needed.           ________________________________________________________________


Do you have any medical and/or physical conditions that would affect your performance as a fire fighter? Yes:____ No:____ If yes please describe.________________________________________


List other organizations or references:_________________________________________


All applicants under the age of 18 years old shall obtain signed permission from parent or guardian. Working papers MUST be obtained before application will be considered.


            Parent/Guardian:_____________________ Date:___/___/_____


Have you ever been convicted of a felony? Yes:____ No:____ If YES explain.


            __________________________________________________________________


The information on this application is true to the best of my knowledge. False information is grounds for rejection or dismissal from company.


Signature:_____________________________ Date:___/___/_____



Fire Company Sponsor:______________________________ Date:___/___/_____


Application Fee of $3.00 paid. Yes:____ No:____ {Under age 18 free}


  I authorize Ridge Fire Company No.1 to contact any and all my references. I understand that a criminal record check may be conducted through the state and/or local enforcement agencies and I authorize such agencies to release records concerning my criminal background and history. I understand that the discovery of any misrepresentation or omission may be a cause for denial of membership to Ridge Fire Co.


Signature:___________________________________

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Office Use Only:


Investigation Committee Report


__________________________________ Accept:_____ Reject:_____


__________________________________ Accept:_____ Reject:_____


__________________________________ Accept:_____ Reject:_____


Accepted:_____ Rejected:_____ From membership Date:___/___/_____


Company Secretary:______________________________ Date:___/___/_____