CARNEYS POINT FIRE DEPT. AUXILIARY
MEMBERSHIP APPLICATION
DATE_____________________________________
NAME:___________________________________________________________________________________________
ADDRESS:________________________________________________________________________________________
CITY, STATE, &
ZIP:_______________________________________________________________________________
TELEPHONE
#:_____________________________________________________________________________________
LENGTH OF
RESIDENCE:___________________________________________________________________________
PRIOR
RESIDENCE:________________________________________________________________________________
_____________________________________________________________________________
LENGTH OF
RESIDENCE:___________________________________________________________________________
OCCUPATION:____________________________________________________________________________________
NAME OF
EMPLOYER:______________________________________________________________________________
ADDRESS OF
EMPLOYER:__________________________________________________________________________
___________________________________________________________________________
LENGTH OF
EMPLOYMENT:_________________________________________________________________________
ARE YOU AT LEAST 21 YEARS OLD? YES _______ NO ________
ARE YOU THE SPOUSE OF A MEMBER OF THE CARNEYS POINT FIRE DEPARTMENT?
YES_____ NO______
IF YES, PLEASE STATE FIRE DEPARTMENT MEMBER’S NAME
___________________________________
ARE YOU RECOMMENDED BY AN AUXILIARY MEMBER? YES _______ NO_______
IF YES, PLEASE STATE AUXILIARY MEMBER’S NAME
______________________________________
YOUR AGE __________ BIRTHDAY ___________________
REASON FOR APPLICATION:
_______________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Thank you for your application. We will review your application and
contact you as soon as possible. If approved
by our membership, you will be given a copy of our Constitution and
By-Laws to read and if you are in agreement with
them you may attend our next meeting as a probationary member.
SIGNATURE:_______________________________________________________________________________________
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webmaster@cpfd-aux.info
or email us and we can send you one in the mail