Membership - North Syracuse Volunteer Fire Department

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North Syracuse Fire Department is actively recruiting volunteers · Fire · EMS · Rescue · Bunk-In Program · Apply today! North Syracuse Fire Department is actively recruiting volunteers · Fire · EMS · Rescue · Bunk-In Program · Apply today! North Syracuse Fire Department is actively recruiting volunteers · Fire · EMS · Rescue · Bunk-In Program · Apply today!

Membership Application Form

Application Date

Date of Birth *

Use MM/DD/YYYY

Age

You must be 18 or older to apply. If you are a college student, see if our Bunk-in Program is right for you.

I am not eligible to apply

First Name *

Last Name *

Address *

City *

State *

Zip *

Home Phone

Work Phone

Cell Phone

Email address *

Why do you want to become a member of the North Syracuse Volunteer Fire Department? *

Residency Information

Resident Since *

How long at current address

New York State Resident Since *

Birthplace *

Are you a citizen of the United States? *

Yes

Do you have the legal right to remain permanently in the United States *

Yes

Personal Information

Have you ever been known by another name? *

Yes

(e.g. marriage)

Please list: *

Gender *

Male

Female

Non-binary

Prefer not to say

Hair Color *

Eye Color *

Height *

Weight *

Do you wear glasses? *

Yes

Contacts

Have you ever received disability or compensation benefits for any injury? *

Yes

Please provide dates and details *

Do you have any restrictions that might/will affect your ability to participate in fire department activities? *

Yes

Please explain *

Do you have a Driver's License? *

Yes

State *

Class *

ID *

List any violations: *

Emergency Information

In case of an emergency, notify:

Name *

Phone *

Relationship *

Physician

Phone

Hospital Preference

Blood Type *

Availability

Indicate your availability to participate in normally required fire department activities (meetings, drills, and emergency calls).

Days

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Evenings

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Nights

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Military Service

Have you served in the United States Armed Forces? *

Currently Serving (Active Duty, Reserve, or National Guard)

Previously Served — Honorably Discharged

Previously Served — Other Discharge

Never Served

Please provide dates and details *

Employment

Are you employed? *

Yes

May we contact your employer? *

Yes

Employer

Employer Address

Occupation

Hours of employment

Supervisor

Supervisor Phone

Last Employer

Address

Supervisor

Supervisor Phone

Education

Highest Education Level *

High School

Year of Graduation

High School Address

College

City

Degree

College

City

Degree

Technical/Trade School

Major

List other special training, skills or experience:

References

Please list three people in your circle of friends (non-family) who have known you for at least 3 years (people you socialize with):

Reference 1

Name *

Address

Phone Number

Email Address

Reference 2

Name *

Address

Phone Number

Email Address

Reference 3

Name *

Address

Phone Number

Email Address

List the names of any current or past members of this organization that you are acquainted with:

Please list two people who can attest to your qualifications and/or interest in this organization:

Person 1

Name *

Address

Phone Number

Email Address

Person 2

Name *

Address

Phone Number

Email Address

Firematic Education/Experience

Not required, all training provided

Department

Phone Number

Chief

Address

Letter of Recommendation *

Yes

Member in good standing? *

Yes

Date of Membership

List additional membership:

Positions Held

Firematic Training/Schools - List any course, completion date, certificate number and location:

List additional schools:

EMS Education/Experience

Not required, all training provided

Organization

Phone Number

Director

Address

Letter of Recommendation *

Yes

Member in good standing? *

Yes

Date of Membership

List additional memberships:

Positions Held

EMS Training/Schools - List any course, completion date, certificate number and location:

List additional schools:

All information contained/or obtained herin will remain confidential

State of New York
County of Onondaga
Village of North Syracuse

I, being duly sworn, depose and say that I am the above named person. I affirm under penalty of perjury that I signed the foregoing statement. I personally read and printed by hand or typed answers to each and every question therein. I do solemnly swear that each and every answer is true, correct and complete in every respect. I acknowledge that any false information that I provided can preclude me from membership of this department.

I confirm that all information provided is true and accurate *

Legal Name *

Signature *

Date Signed: August 05, 2026