Membership Application
Email address
Type of Membership
Required
First and Last Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Address (Street, City, Zip)
Your answer
Occupation
Your answer
Primary Phone Number
Your answer
Secondary Phone Number
Your answer
Do you have a valid Driver's License
Driver's License Number
Your answer
Has your driving privilege ever been revoked or suspended?
If yes, please explain. List court, date of incident, and penalty.
Your answer
Have you ever been arrested?
If yes, please explain. List date, location, and reason for the arrest.
Your answer
Have you ever been convicted or entered a plea of guilty to a crime other than a motor vehicle violation?
If yes, please explain. List court, date, and settlement of the court.
Your answer
Would you be willing to submit to a police background check?
Do you have any first aid, rescue, or medical training?
If yes, please explain.
Your answer
Are you willing to attend an EMT course?
Please list any previous affiliation with Fire, EMS, or Emergency Services (location, dates of service, type of membership).
Your answer
Do you have any physical, medical, or other restrictions that may affect your duties as a squad member?
If yes, please explain.
Your answer
Please provide two personal references that you have known for at least one year (not relatives or members of HBES).
Reference 1 (include full name, address, and primary phone number)
Your answer
Reference 2 (include full name, address, and primary phone number)
Your answer
Briefly explain why HBES would benefit from having you as a member. What do you expect to gain from becoming a member? Why do you want to volunteer?
Your answer
I have, to the best of my knowledge and ability, answered all questions for reference purposes and hereby give my consent to any investigation. I also agree to abide by the rules and regulations of HBES and also agree to return any squad equipment issued to me upon request of the Chief, President, or designee. (Your typed name will act as a digital signature)
Full Legal Name
Your answer
If the applicant is a cadet, parent or legal guardian full legal name (your typed name will act as a digital signature).
Your answer
Please download and complete the file below. Background checks should be completed prior to your interview.
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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