Membership Application - New Windsor Fire Department

Applicant’s Full Name Required

Last, First, Middle Initial

Home Address Required

Street Address, City, State, Zip Code

How long have you lived at this address?

Home Phone #

Cell Phone #

Email Address Required

Date of Birth Required

Sex

Male Female

Please provide the last 5 digits of your social security number:

This information is used to verify training certificates

Driver’s License #

Driver's License Class

Driver’s State Issued

Height

Weight

Where are you currently employed:

Job Title

Supervisor’s Name

May we contact your supervisor?

Yes No

Education Level Required

Other Education

Please list any other technical/professional degrees

Have you ever filed an application with the New Windsor Fire Department: Required

Yes No

If so, when?

Have you ever been a member if any other fire or rescue department(s)?: Required

Yes No

If you have been a member of any other fire or rescue department please list department name(s) and date(s):

Have you ever been denied membership to a fire and/or rescue department?: Required

Yes No

If so, please give details:

Have you ever been discharged for misconduct or unsatisfactory service or asked to resign from a fire and/or rescue department?: Required

Yes No

If you have been discharged, please give details:

List any firefighting and/or emergency medical certifications that are current. Please provide copies of the certifications:

Please provide copies of certifications:

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Please list any other professional or volunteer experience that you may have

List any special training, skills or interests you may have

Please list any medical restrictions that might/will affect your ability to fulfill the requirements for the classification of membership you have applied for

Please list any restrictions that might/will affect your availability for volunteer work (work schedule, etc.)

Have you ever been convicted of a felony offense? Required

No yes

If yes, please provide details

Reference #1 Required

Name, Address, Phone Number

Reference #2 Required

Name, Address, Phone Number

Reference #3 Required

Name, Address, Phone Number

Primary Emergency Contact #1 Required

Name, Relationship to You, Address, Phone Number, Additional Phone Number

Emergency Contact #2 Required

Name, Relationship to You, Address, Phone Number, Additional Phone Number

Electronic Signature Required

How did you hear about us?

Facebook Friend Member Recruitment Flier State Recruitment Program County Recruitment Program

Date Submitted

10/25/2026 0453

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY.

The facts set forth in my application for membership are true and correct. I understand that a false statement on this application may be considered cause for rejection of this application or termination of my membership. I hereby authorize the New Windsor Fire Department to conduct a work history, reference check, and/or police inquiries as it deems appropriate, and I further release the New Windsor Fire Department of any circumstances that may come out of any investigations. (Note: any information retrieved will be kept confidential and treated as personal). I understand that nothing contained in the membership application promises anything regarding membership, and I understand that no such promise is binding upon the New Windsor Fire Department unless made in writing.

If elected to the Department, I understand that I am a part of the New Windsor Fire Department, and therefore I can be requested to resign or be terminated or expelled from membership. Causes for termination or expulsion from membership may include, but are not limited to:

Failure to comply with the bylaws of the Department
Failure to comply with the policies and procedures of the Department
Providing false or misleading information on this application

By my electronic signature above, I affirm that I have read and understood these statements and I further agree to the provisions contained herein.