« Back to Results
Norfolk Volunteer Fire Department
Norfolk Vol Fire Dept
PO Box 511
Norfolk, NY 13667
315-384-4581
Description
Norfolk is located in the northern part of St. Lawrence County, NY. As of the 2010 Census, our primary first due area has a population of 4,795 with 56.9 sq. mi. We have 50 active members, all volunteers. The Norfolk Fire Department provides structural fire suppression, wildland fire suppression, rescue ops, and we offer a fire prevention program to the residents of the Town of Norfolk. We provide automatic aid. We operate out of 3 stations and respond to approximately 140-150 calls per year. Our ISO rating is 5/5. We provide opportunity for junior members and are actively recruiting for members across our entire community.
Volunteer Category: Firefighter, Junior Members
Requirements
NORFOLK VOLUNTEER
FIRE DEPARTMENT
MEMBERSHIP
APPLICATION
FREEDOM OF INFORMATION
Within the freedom of information law, all information contained or obtained herein will remain confidential and will be used only for internal membership processing.
Privacy Notification
Section 94 of the Public Officers Law [Personal Privacy Protection Law]
that you be notified of the following facts when information, which will be maintained in a record system, is correct from you.
The authority to request and confirm personal information on you is found in Article 6 of the Executive Law.
The information obtained will;
1] Be used to determine your qualifications for the position of which you applying.
2] Be released to All necessary members of the Norfolk Vol Fire Department [i.e.] Chief, President, Secretary, Investigation Committee and Board of Fire Commissioners.
3] Be maintained in your personal file [if you are accepted as a member] or in our resume file for six months [if you are not accepted as a member].
Sign__________________________________________
Applicant’s Authorization for Release of Information
In order to confirm the information I have supplied on my application for membership with the Norfolk Volunteer Fire Department, I authorize all licensing, educational institutions, law enforcement agencies, present and former employers, and the military services to disclose their relevant records about me to the Norfolk Volunteer Fire Department, weather the information be of public, private, or confidential nature;
I release them from any liability and responsibility from doing so.
This authorization, in original copy form, shall be valid for this and any future information, reports, or updates that may be requested.
I understand that this form will accompany requests for official documents and confirmation of my credentials.
_____________________________
Applicant’s Name [print]
_____________________________ Date ________________________
Applicant’s Signature
_____________________________
Witnessed by and Title [Print]
_____________________________ Date ________________________
Witnessed by Signature
Norfolk Volunteer Fire Department
Application for Membership
Name _______________________________________________AKA_________________________
Mailing Address ________________________________911 Address__________________________
Telephone Home __________________Cell # ____________________Work____________________
Date of Birth ____________________Place of Birth________________________________________
Social Security # ___________________________________________________________________
Name of Employer ______________________________________________Phone #______________
Hair Color___________ Height__________ Weight___________ Eye Color_________
Do you have a valid New York Driver’s License? ________ I.D # _____________________________
Previous Emergency Services Experience ________________________________________________
Contact Name ________________________________________________Phone # _______________
List any New York State Training ______________________________________________________
______________________________________________________
______________________________________________________
List [ 3 ] Personal References other than any members of this organization.
Name ______________________________________________________ Phone # ________________
Name ______________________________________________________ Phone # ________________
Name ______________________________________________________ Phone # ________________
Name of member of this organization for Personal Reference __________________________________
Would you be willing to submit to a Drug and Alcohol test at any time? Yes / No
Sign ___________________________________________
Will you follow all rules and regulations set forth by the Norfolk Volunteer Fire Department and the Norfolk Board of Fire Commissioners? Yes / No
Sign____________________________________________
Would you submit to a Physical Examination? Yes / No
Sign____________________________________________
All applicants will appear in front of an Investigation Committee.
This application has been submitted this day of____________20___ by the undersigned applicant who affirms that the statements made herein are true under penalties of the law.
Applicant’s Name [print]___________________________________________________
Applicant’s Sign__________________________________________________________
Witnessed by_____________________________________________________________
IF YOU HAVE ANY PREVIOUS EXPERIENCE YOU MUST OBTAIN A LETTER OF RECOMMENDATION FROM THE OFFICER IN CHARGE OF THAT ORGANIZATION AND ATTACH IT TO THIS APPLICATION BEFORE YOUR APPLICATION CAN BE PROCESSED
References checked on for _________________
1st person called ___________________________Phone #___________________
What kind of person is _______________________________________________
How do you know person _____________________________________________
Do you think person can do the job ______________________________________
Is person honest and trusting __________________________________________
Would this person be a good member? _________________________________
2nd person called ___________________________Phone #__________________
What kind of person is _______________________________________________
How do you know person _____________________________________________
Do you think person can do the job ______________________________________
Is person honest and trusting __________________________________________
Would this person be a good member? _________________________________
3rd person called ___________________________Phone #__________________
What kind of person is _______________________________________________
How do you know person _____________________________________________
Do you think person can do the job ______________________________________
Is person honest and trusting __________________________________________
Would this person be a good member? _________________________________
FIRE DEPARTMENT
MEMBERSHIP
APPLICATION
FREEDOM OF INFORMATION
Within the freedom of information law, all information contained or obtained herein will remain confidential and will be used only for internal membership processing.
Privacy Notification
Section 94 of the Public Officers Law [Personal Privacy Protection Law]
that you be notified of the following facts when information, which will be maintained in a record system, is correct from you.
The authority to request and confirm personal information on you is found in Article 6 of the Executive Law.
The information obtained will;
1] Be used to determine your qualifications for the position of which you applying.
2] Be released to All necessary members of the Norfolk Vol Fire Department [i.e.] Chief, President, Secretary, Investigation Committee and Board of Fire Commissioners.
3] Be maintained in your personal file [if you are accepted as a member] or in our resume file for six months [if you are not accepted as a member].
Sign__________________________________________
Applicant’s Authorization for Release of Information
In order to confirm the information I have supplied on my application for membership with the Norfolk Volunteer Fire Department, I authorize all licensing, educational institutions, law enforcement agencies, present and former employers, and the military services to disclose their relevant records about me to the Norfolk Volunteer Fire Department, weather the information be of public, private, or confidential nature;
I release them from any liability and responsibility from doing so.
This authorization, in original copy form, shall be valid for this and any future information, reports, or updates that may be requested.
I understand that this form will accompany requests for official documents and confirmation of my credentials.
_____________________________
Applicant’s Name [print]
_____________________________ Date ________________________
Applicant’s Signature
_____________________________
Witnessed by and Title [Print]
_____________________________ Date ________________________
Witnessed by Signature
Norfolk Volunteer Fire Department
Application for Membership
Name _______________________________________________AKA_________________________
Mailing Address ________________________________911 Address__________________________
Telephone Home __________________Cell # ____________________Work____________________
Date of Birth ____________________Place of Birth________________________________________
Social Security # ___________________________________________________________________
Name of Employer ______________________________________________Phone #______________
Hair Color___________ Height__________ Weight___________ Eye Color_________
Do you have a valid New York Driver’s License? ________ I.D # _____________________________
Previous Emergency Services Experience ________________________________________________
Contact Name ________________________________________________Phone # _______________
List any New York State Training ______________________________________________________
______________________________________________________
______________________________________________________
List [ 3 ] Personal References other than any members of this organization.
Name ______________________________________________________ Phone # ________________
Name ______________________________________________________ Phone # ________________
Name ______________________________________________________ Phone # ________________
Name of member of this organization for Personal Reference __________________________________
Would you be willing to submit to a Drug and Alcohol test at any time? Yes / No
Sign ___________________________________________
Will you follow all rules and regulations set forth by the Norfolk Volunteer Fire Department and the Norfolk Board of Fire Commissioners? Yes / No
Sign____________________________________________
Would you submit to a Physical Examination? Yes / No
Sign____________________________________________
All applicants will appear in front of an Investigation Committee.
This application has been submitted this day of____________20___ by the undersigned applicant who affirms that the statements made herein are true under penalties of the law.
Applicant’s Name [print]___________________________________________________
Applicant’s Sign__________________________________________________________
Witnessed by_____________________________________________________________
IF YOU HAVE ANY PREVIOUS EXPERIENCE YOU MUST OBTAIN A LETTER OF RECOMMENDATION FROM THE OFFICER IN CHARGE OF THAT ORGANIZATION AND ATTACH IT TO THIS APPLICATION BEFORE YOUR APPLICATION CAN BE PROCESSED
References checked on for _________________
1st person called ___________________________Phone #___________________
What kind of person is _______________________________________________
How do you know person _____________________________________________
Do you think person can do the job ______________________________________
Is person honest and trusting __________________________________________
Would this person be a good member? _________________________________
2nd person called ___________________________Phone #__________________
What kind of person is _______________________________________________
How do you know person _____________________________________________
Do you think person can do the job ______________________________________
Is person honest and trusting __________________________________________
Would this person be a good member? _________________________________
3rd person called ___________________________Phone #__________________
What kind of person is _______________________________________________
How do you know person _____________________________________________
Do you think person can do the job ______________________________________
Is person honest and trusting __________________________________________
Would this person be a good member? _________________________________
40.7127753
-74.0059728
