Brooklin Volunteer Fire Company

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Brooklin Fire Department Application For Junior Membership

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Thanks very much for your interest in the Brooklin Fire Department!

Please complete all fields in this application. We will be in touch with you and your parent or guardian shortly after you submit the form.

If you would like to discuss before completing the application, call:

Chief Sam Friend at 669-2469

or

Assistant Chief Tommy Morris at 619-3360

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Prefix
First Name
Last Name
Suffix

Enter your middle name if you have one

Enter your preferred nickname if it differs from your first name
*
check each method that we can use to contact you





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Check all that apply

What did we miss on our list?

Enter the name of the place where you work or go to school

What grade or program are you in?

enter your start date as close as you can remember (doesn't have to be exact)

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
*

(mm/dd/yyyy)

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
*

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

(mm/dd/yyyy)

(mm/dd/yyyy)

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

(mm/dd/yyyy)

(mm/dd/yyyy)

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

(mm/dd/yyyy)

(mm/dd/yyyy)

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

(mm/dd/yyyy)

(mm/dd/yyyy)
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You will need their permission to join.
You may want to talk to them first

You may want to discuss your interest in the fire department with your parent(s) or guardian(s) before you submit this form. This form will automatically generate an email to them and they may not like to be surprised.

Assure them that you and they will meet with department leadership before you start to discuss what a junior membership entails and give them and you an opportunity to specify any activities that will be off-limits for you.

Feel free to contact Sam or Tommy at the numbers shown on the top of this page before you discuss with them if you would like any additional guidance.

 

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First Name
Last Name
*


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check each type of phone that we can use to contact your emergency contact



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Age and Health
*
check each type of phone that we can use to contact your emergency contact
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The state that issued your driver's license
*

enter your driver's license number
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(mm/dd/yyyy)
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(mm/dd/yyyy)
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Volunteer areas of interest
Select any jobs in each category that would interest you
Select any jobs in each category that would interest you. NOTE that not all of these tasks require medical certification
Select any jobs in each category that would interest you
Select any jobs in each category that would interest you

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*
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Provide the name and rank of a leader at the previous organization that we can contact


indicate the date that you started (approximate month and day are OK)
are you an active member

indicate the date that you became inactive (approximate month and day are OK)

Describe why you ceased to be active with that agency
*



Provide the name and rank of a leader at the previous organization


indicate the date that you started (approximate month and day are OK)
are you an active member

indicate the date that you became inactive (approximate month and day are OK)

Describe why you ceased to be active with that agency
check all that apply


*

*

*

*

Job History
List any jobs that you have currently or have had in the past

Name of Organization / employer / business. Leave blank if none


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

Using mm/dd/yyyy format, enter your start date as close as you can remember (doesn't have to be exact)

Using mm/dd/yyyy format, enter your day there as close as you can remember (doesn't have to be exact). Leave blank if you are still there







Name of Organization / employer / business. Leave blank if none


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

Using mm/dd/yyyy format, enter your start date as close as you can remember (doesn't have to be exact)

Using mm/dd/yyyy format, enter your day there as close as you can remember (doesn't have to be exact). Leave blank if you are still there






Name of Organization / employer / business


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

Using mm/dd/yyyy format, enter your start date as close as you can remember (doesn't have to be exact)

Using mm/dd/yyyy format, enter your day there as close as you can remember (doesn't have to be exact). Leave blank if you are still there






Name of Organization / employer / business


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

Using mm/dd/yyyy format, enter your day there as close as you can remember (doesn't have to be exact). Leave blank if you are still there






Name of Organization / employer / business


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

Using mm/dd/yyyy format, enter your start date as close as you can remember (doesn't have to be exact)

Using mm/dd/yyyy format, enter your day there as close as you can remember (doesn't have to be exact). Leave blank if you are still there






Name of Organization / employer / business


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

Using mm/dd/yyyy format, enter your start date as close as you can remember (doesn't have to be exact)

Using mm/dd/yyyy format, enter your day there as close as you can remember (doesn't have to be exact). Leave blank if you are still there






Name of Organization / employer / business


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

Using mm/dd/yyyy format, enter your start date as close as you can remember (doesn't have to be exact)

Using mm/dd/yyyy format, enter your day there as close as you can remember (doesn't have to be exact). Leave blank if you are still there






Name of Organization / employer / business


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

Using mm/dd/yyyy format, enter your start date as close as you can remember (doesn't have to be exact)

Using mm/dd/yyyy format, enter your day there as close as you can remember (doesn't have to be exact). Leave blank if you are still there






Name of Organization / employer / business


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

Using mm/dd/yyyy format, enter your start date as close as you can remember (doesn't have to be exact)

Using mm/dd/yyyy format, enter your day there as close as you can remember (doesn't have to be exact). Leave blank if you are still there






We are not here to judge. Help us understand the situation.