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South Line Volunteer Fire Company, Inc.
1049 French Road Cheektowaga, New York 14227

APPLICATION FOR ACTIVE MEMBERSHIP

Application Fee Disclaimer
There is a $20.00 application fee that is required when submitting an application for membership. After submitting your application, a representative from the South Line Fire Company will be in contact with you to verify and complete your application process. Please be ready with this $20.00 at this point.
Date of Application *
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Personal Information
Please note. All personal information entered within this application will be kept confidential and used only for its' intended purpose of membership to the South Line Fire Company.
Last Name *
Your answer
First Name *
Your answer
Middle Name
* If Applicable
Your answer
Current Home Address *
* Include Street, City, State and Zip Code. Active Membership into the South Line Fire Company is limited to those individuals who reside within the Fire Company response area and immediate surrounding areas. If you are unsure if you meet these guidelines, complete our application and we will discuss further when one of our representatives reaches out to you.
Your answer
Prior Address
* If you have lived in your current address for less then 5 years, please include your previous address here. Include street, city, state and zip code.
Your answer
Phone Number *
* Please include the best number to get a hold of you.
Your answer
E-Mail Address *
* Please include the best email address for you in case we need to contact you this way.
Your answer
Social Security Number *
* This is required when conducting your background check prior to joining the Fire Company. Please remember, all information is kept confidential and secure within the Fire Company.
Your answer
Date of Birth *
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Marital Status
* Please note if you are single or married. When joining an organization, we believe it should be a joint decision if it is warranted. Thank you!
Your answer
Spouse Name
Your answer
Driver's License Number *
* A valid New York State driver's license is required for membership into the Fire Company. If you do not have one, but are in the process of getting one, please note that in the answer field.
Your answer
Driver's License Expiration Date
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Driver's License Class *
Have you ever been convicted of a crime? *
If you answered yes to the above question, please provide an explanation.
Your answer
Prior Experience
Are you currently or have you ever been a member of a Fire Company? *
If Yes, what was your length of duty with that company?
* If this is not applicable, please skip this question.
If you are currently or have been a member with a Fire Company, please provide the companies name and address here.
* If this is not applicable, please skip this question.
Your answer
Are you currently an Exempt Member of a Fire Company? *
If you have been a member of a previous Fire Company, do we have your permission to contact that Company on your behalf?
* If this is not applicable, please skip this question.
Education
High School. *
Please include the name and address of your High School.
Your answer
Was a Diploma Earned? *
High School Graduation Date.
* Approximate Month and Year will be fine.
MM
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College.
* Please include the name and address of the college you attended. If this is not applicable, please skip this question.
Your answer
College Graduation Date.
* Approximate Month and Year will be fine.
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DD
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Did you earn a College Degree?
Employment Information
Current Employer *
* Provide the name of your current employer. If you are not working currently, please put "unemployed."
Your answer
Employer's Address *
Your answer
Employer Contact Name and Phone Number *
Your answer
What is your current position at your place of work? *
Your answer
What is your normal work schedule? *
References
* Please provide employment or character references that we can contact.
Reference #1 *
* Please provide name, phone number and address.
Your answer
Reference #2 *
* Please provide name, phone number and address.
Your answer
Reference #3 *
* Please provide name, phone number and address.
Your answer
Acknowledgement
I SWEAR AND ACKNOWLEDGE THAT THE ABOVE ANSWERS ARE TRUE AND CORRECT. I FURTHERMORE PROMISE IF MY APPLICATION IS ACTED UPON FAVORABLY, I WILL ABIDE BY THE CONSTITUTION AND BYLAWS OF THE FIRE COMPANY. I WILL ACT HONORABLY AND SPEAK PROFESSIONALLY IN THE BEST INTEREST OF THE CHEEKTOWAGA SOUTH LINE VOLUNTEER FIRE COMPANY.
If you agree with the above statement, please write your full name here. *
Your answer
Authorization
* I HEREBY AUTHORIZE THE CHEEKTOWAGA SOUTH LINE FIRE COMPANY TO INITIATE A MEDICAL EXAM, CRIMINAL BACKGROUND, DRIVING RECORD CHECK, DRUG TEST, ARSON CHECK, AND SEXUAL OFFENDER CHECK.
If you agree with the above statement, please write your full name here. *
Your answer
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