Join Us – Cherry City VFC

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth *//

Phone *

Type of Membership Applying For: *

Cadet Firefighter (14-17 Year Old)
Active Firefighter
Business Member (18 years +)
Honorary Member to Active

Email *

Driver's License Number

Driver's License Class

Class A
Class B
Class C

Employment Information

Current Employer

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Occupation

How Long Have You Worked Here?

Emergency Contact Information

Emergency Contact Name *

First

Last

Emergency Contact Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact Phone *

Relationship *

Have You Ever Been Arrested? If YES, Please Explain *

Do You Have Any Medical Conditions or Limitations? If Yes, Please Explain *

Have You Been a Member of Another Fire Company? *

Yes
No

If Yes, Please Provide Company Name, Date You Left, Phone Number and Reason For Leaving

Education

Are You A Current Student?

Yes
No

If YES, What School Are You Currently Enrolled?

Highest Level of Education Completed

High School
Associate's Degree
Bachelor's Degree
Post-Undergraduate Degree

Do You Have Any Specialized Training?

Authorization and Submission

By clicking SUBMIT below, I verify all of the information provided is correct to the best of my knowledge. *

I Accept

By clicking SUBMIT below, I am authorizing my signature as submission to this application *

I Accept

Employment Information

Emergency Contact Information

Education

Authorization and Submission

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