Vista Fire Department Membership Application
If you are interested in becoming a member of the Vista Fire Department, please read thoroughly and completely fill out the application following all instructions in each section as listed below. If you have any questions, please email 'info@vistafd.org'.

We welcome your interest in applying for membership in Vista Fire Department! Vista FD is an all-volunteer, not-for-profit organization dedicated to providing effective emergency services (fire, rescue, and EMS) to the Vista Fire District community. We take our mission seriously! We seek individuals who can advance a hose into a burning building, stop the bleeding of a patient, drive an ambulance, or operate a pumper. In a genuine emergency, lots of able hands are needed. If you are willing and able, we’ll provide the emergency services training.

However, we also seek members with expertise in accounting, communication, computers, finance, food preparation, grant writing, law, marketing, public relations, and numerous other skills to help us in areas other than direct emergency operations. Most importantly, we seek individuals with a willing, can-do attitude who can reliably contribute to a team.

Although membership is voluntary, we consider it a commitment. All members are expected to attend meetings and to maintain proficiency in their role within the Department. In addition, Active members are expected to drill weekly and respond to emergency calls.

You won’t mistake us for a social club – this is a serious, disciplined, life-saving endeavor. We believe you will find participation in Vista FD to be an extraordinarily challenging and satisfying experience.

Vista Fire Department, Inc. does not discriminate on the basis of race, color, creed, national origin, sex, marital status, religion, or freedom from disability. New York State law prohibits individuals from membership in volunteer fire companies who have been convicted of, or pled guilty to, the crime of arson.
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Privacy Notification
Section 94 of the Public Officers Law (Personal Privacy Protection Law) requires that you be notified of the following facts when information which will be maintained in a record system is collected from you. The authority to request and confirm personal information about you is found in Article 6 of the Executive Law. The information obtained will be:
- Used to determine your qualifications for the position for which you are applying;
- Released to the chief and your potential supervisors; and
- Maintained in your personnel file (if you become a fire company member) or in our resume file for six months (if you are not a fire company member).

Failure to provide the information or authorization will result in your application not being considered for membership.

The information will be maintained by the Secretary of Vista Fire Department, Inc., 377 Smith Ridge Road, South Salem, New York 10590, telephone number 914-533-2727.

Within the Freedom of Information Law, all information contained or obtained herein will remain confidential and will be used only for internal membership processing.
Please provide your complete first name, middle initial, and last name *
Please provide your complete home address (Street name and number, town, state, and zip code) *
How long have you resided at this address? *
Please provide your preferred contact phone number and indicate type (Mobile, Home, Work) etc. *
Please provide your mobile phone number and carrier, if you do not have a mobile phone, please simply answer N/A *
Please provide your preferred contact email address *
What is your age and date of birth? *Individuals under the age of 16 are not eligible for membership* *
Do you have a driver's license valid in New York State or Connecticut? *
Is additional information about a change in your name, or use of an assumed name or nickname, necessary to enable a check on your eligibility for membership? If yes, please explain below. If no, simply answer 'no'. *
Are you currently employed or a student? *
May we contact your employer/school as a reference? *
If we may contact your employer/school, please provide the following information: Company/School Name, Street Address, City, State, Zip Code, Immediate Supervisor OR School Official (Name and Phone Number). If no, simply answer "N/A" *
Have you ever been a member of the United States Armed Forces? *
Were you ever dishonorably discharged from any of the United States Armed Forces? If yes, please explain below. If this does not apply to you, simply type 'N/A'. *
Have you ever been convicted of, or pled guilty to, a felony, misdemeanor, insurance fraud, arson, or to a reduction of one of these offenses? If yes, please explain below. If not, simply answer 'no'. *
Please select which membership category you are applying for. Active members are directly involved in and respond to emergencies as first responders (i.e. Firefighter, Ambulance/Engine Driver, Emergency Medical Technician). Associate members participate in the business aspects of the non-operational side of the department known as the "house" and may hold roles in public relations, marketing, finance, fundraising, and other areas related to running a not-for-profit corporation. *
Please use the space below to identify any previous emergency services experience you have. Include only fire, rescue, emergency medical service, and police agencies. Please provide complete contact information for every agency for which you have been a member for any length of time. We may reach out to one or all of these agencies as part of your background investigation. If you have no previous emergency services experience, simply answer 'none'. *
Please provide complete contact information (full name, street address, city, state, zip code, and best contact phone number) for a personal reference. This individual must not be related to you, or currently a member of the Vista Fire Department. *
Application Fee
Please use the following link to submit a $5 application fee.

https://www.paypal.com/donate/?hosted_button_id=X8HMWK9MV7F7E

The Vista Fire Department processes all application fees via Paypal. After following the link above and typing in $5.00, please write your name and "application fee" in the box that says "add special instructions to the seller".

Applications will not be accepted without an associated fee payment and matching name. If you need any assistance with this step, please email 'info@vistafd.org'.
Application Affirmation and Authorization of Release of Information
I hereby agree that, in the event of my election to membership, I will comply with the mission, by-laws, and policies of Vista Fire Department, Inc. Additionally, I attest to all information entered within this application and to its accuracy. I understand that any information that is found to be intentionally omitted or dishonest may jeopardize my application for membership with the Vista Fire Department, and may be entered into permanent record should I be elected to membership.

In order to confirm the information I supplied on my application for membership to Vista Fire Department, Inc. (“the Fire Company”), I authorize all licensing agencies, educational institutions, law enforcement agencies, present and former employers, and the military services to disclose their relevant records about me to the Fire Company whether the information be of public, private, or confidential nature; and I release them from any liability and responsibility for doing so.

This authorization, in original form, shall be valid for this and any future information, reports, or updates that the Fire Company may request.

I understand that this form will accompany requests for official documents and confirmation of my credentials.
Applicant Affirmation and Authorization of Release of Information Electronic Signature: I agree that by typing my full legal name below and submitting this application, my electronic signature shall be of the same legal effect, validity, or enforceability as a manually executed signature or the use of a paper-based record keeping system, to the extent of and as provided for in any applicable law. Please type your full legal name below to electronically sign your application and certify your understanding of and acceptance to all terms, agreements, releases, and sections of this application. *
If you are under the age of 18, please have a parent or your legal guardian electronically sign below. Electronic Signature: I agree that by typing my full legal name below and submitting this application on behalf of my child/legal dependent, my electronic signature shall be of the same legal effect, validity, or enforceability as a manually executed signature or the use of a paper-based record keeping system, to the extent of and as provided for in any applicable law. Please type your full legal name below to electronically sign your application and certify that you understand and accept all terms, agreements, releases, and sections of this application on behalf of your child/dependent, and that you have the legal authority to do so.
Please provide your parent's/legal guardian's information if different from your own (full name, street address, city, state, zip code, best contact phone number)
Witness to Applicant Affirmation and Authorization of Release of Information Electronic Signature: I agree that by typing my full legal name below and submitting this application as a witness to the applicant's attestation and authorization, my electronic signature shall be of the same legal effect, validity, or enforceability as a manually executed signature or the use of a paper-based record keeping system, to the extent of and as provided for in any applicable law. Please type your full legal name below to electronically sign your application and certify that you have witnessed the named applicant agree to and accept all terms, agreements, releases, and sections of this application. *
Please indicate the date this application was signed and submitted *
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Type this code: S94Y5N *
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