Name                                                             Home Phone
      
Address                                     City                                    Age
       Sex: M F  Marital Status: Single Married
Place of Employment:


Were you ever a Firefighter:  Yes No     If yes, where: How Long:
Do you belong to any Fire Department Yes No     If yes, where:

When you become a firefighter, will you attend regular company meetings, attend all fires possible, take active part in all activities of the Department.    Yes No
            HAVE YOU EVER BEEN CONVICTED OF A FELONY? YES NO - NOTE- A POLICE BACKGROUND CHECK WILL BE CONDUCTED.

Do you now have, or have you ever been treated for.

1. Abnormal blood pressure.                        No Yes   Please use all drop down menus
2. Any heart condition and/or heart attack? No Yes
3. Epilepsy or mental or nervous ailment?     No Yes
4. Any other disability or handicap?            No Yes

Explain: 

5. Drug and/or Alcohol dependency? No Yes

Training required to retain active Membership in the Fire Dept. is Ten (10) Hours on Members Company apparatus within Six (6) Months and you must receive a certificate in Fundamentals in Firefighting within a Two (2) Year Period.
Is the above Statement on Training thoroughly understood? Yes No

I hereby certify that the answers to above questions are true and any falsification of same will result in automatic dismissal from and void all liability of the Ridgway Fire Department and Ridgway Fireman's Relief Association.

Signature__________________________________Date____/____/_____    Phone_____________________________
 

  18 to 21 Year Oath
 I, the undersigned, do here-by agree to obey the liquor laws of Pennsylvania by not consuming any Alcoholic Beverages during any Ridgway or other Fire Department function. If caught doing so, I will be expelled from the department.

Name of_______________________________________   Signed________________________________________________

Date application rec'd_____/____/_____                       Presented by___________________________________________

 Membership desired in:  Engine 41 Engine 42 Engine 43 Engine 44 Engine 411 RFD Auxiliary RFD Fire Police                       Name of Secy___________________________________________

Applicant must pass physical examination before acceptance.
Applicants must be approved by Company membership.
Applicants are responsible for maintaining up to date beneficiary cards.

Investigating committee:______________________________________________________________________________Captain
                                    _______________________________________________________________________________1st. Lut
                                    _______________________________________________________________________________2nd. Lut

Accepted_____  Rejected______

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          After you have filled out this application, click the printable form button, and print out the application,
          turn it in to the company that you are joining.  Any questions, email us at: ridgwayfire@alltel.net