Membership Application

To begin your application process, please fill out the form and submit it. One of the chiefs will then contact you.

    Name:

    Street Address:

    Mailing Address:

    Email:

    Home Phone:

    Cell Phone:

    Cell Carrier:

    Birthdate:

    Valid Driver’s License?

    Class

    Endorsements:

    Emergency contact:

    Relationship:

    Address:

    Phone:

    Personal reference:

    Relationship:

    Address:

    Phone:

    Employer:

    Work Phone:

    Work days/hours:

    How long have you lived or worked in Ferndale?

    Hours of the day and night that you are available to respond to calls:

    Briefly describe your previous fire and/or medical training and experience:

    What other skills or experience do you have that would be of benefit to the Department?

    Have you ever been convicted of a criminal offense (other than a minor traffic violation), or are there any criminal charges pending against you?