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Have you ever been convicted of any
criminal offense or misdemeanors? Y/N Yes No

Have you ever been part of any other first aid squad or fire department? Y/N Yes No Please select a choi

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The facts set forth in my application of membership are true and complete. I understand that if accepted, false information on this application shall be considered sufficient cause for dismissal. You are hereby authorized to make any investigation of my personal history, criminal history, driving record or bureaus of your choice. In making this application for membership, I authorize you to make an investigative consumer report whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. This inquiry, if made, may include information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make written request within a reasonable period of time to receive additionally detailed information about the nature and scope of any such investigative report that is made.

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