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Nov 21st, 2009 at 10:30 pm
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Application for Membership - (Read 54 Times)
 
Lt. Backdraft
2nd Lieutenant
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Posts: 51
Post Icon Posted: May 19th, 2007 at 07:37 pm
North Thibodaux Fire Co. #1
Org. Feb. 23, 1949
699 St. Patrick Hwy.
Thibodaux, La. 70301


To: President and members of N.T.F.C.

We ______________________ and ________________________, members in good standing of North
Thibodaux Fire Company #1, Thibodaux, La. Realizing our responsibilities and remembering our obligations, do hereby recommend the following individual for membership in our company. We believe the applicant qualifies in accordance with the Constitution and By-Laws of our company.

The undersigned desires to become a member of North Thibodaux Fire Co. #1. I agree to abide by the Constitution and By-Laws of the company and all regulations of the Thibodaux Volunteer Fire Department. If accepted, I promise obedience to it and will comply with the accepted policies of the company in regards to training after acceptance as a member.

I, ________________________, hereby authorize the appropriate company officer or investigating committee to check into my background, including, but not limited to a check with the appropriate local, state, and federal law enforcement agencies. I also waive my right to privacy in those areas. I do understand that any false information on this application will automatically void any chance of membership.


_____________________________ _____________________________
Applicant’s Signature President’s Signature

Fill out all applicable blanks. All information will be checked for accuracy. Any false information will be grounds for rejection of application.

Name: _________________________ D.O.B. ____/____/____ Soc. Sec. # _____-____-_____
Driver License # _________________ Phone #s Day (____) _____-______ Night (____) _____-______
Address: ____________________________________City: __________________ State: ______________

Employer: __________________________________________________ Phone # (____) _____-_______
Supervisor: ____________________________________________ Date of Employment: ____/____/____
Resident of Thibodaux since? ____________________________ Firefighting Experience? Yes / No
If Yes Explain: ____________________________________________________________________________________________________________________________________________________________________________________________

Traffic Violation Record: Yes / No If Yes Explain: ____________________________________________________________________________________________________________________________________________________________________________________________

Criminal Record Yes / No If Yes Explain: ____________________________________________________________________________________________________________________________________________________________________________________________

Any Information that you would like the company to know? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________ _________________________
Member in good standing Member in good standing

« Last Edited by Lt. Backdraft Mar 9th, 2008 at 06:27 pm »
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Board Administrator, Lieutenant FD-2003: Curt J. Faucheaux



 
 

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