Applicant Info (Step 1 of 7)
Contact Info (Step 2 of 7)
Employment Info (Step 3 of 7)
Previous Emergency Experience (Step 4 of 7)
References (Step 5 of 7)
Application Signature (6 of 7)
I, residing on in the Town of Clarence, County of Erie, state of New York, do herby make application for membership in the Clarence Center Volunteer Fire Company, Inc. I certify that I am currently over 18 years of age and a citizen of the United States. I understand and agree that to be elected to membership I must complete a probationary year and fulfill the required training schedule as directed by the Chief, as well as all other duties of an active member as prescribed by the President. At the completion of the one-year period the Chief and President will certify that I have completed the required Firematic training and executive duties and I shall be considered a permanent member. In the event that I do not properly complete my probationary year, I shall be dropped from the rolls of the company without question and be so notified by the corresponding secretary. I agree to be guided by and obey the Constitution and By-laws of the Corporation.

In witness whereof, this application has been subscribed this 25th day of April, 2024 by the undersigned applicant who affirms that the statements made herein are true under the penalty of perjury.

My signature below signifies that I have read and understand the membership application.
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Applicant Signature (click & drag mouse or touchscreen to sign)
Release Form (Step 7 of 7)
Applicants Authorization for Release of Information

In order to confirm the information I supplied on my application for membership with the Clarence Center Volunteer Fire Company, Inc., I authorize all licensing agencies, educational institutions, law enforcement agencies, present and former employers, and the military services to disclose their relevant records about me to the Clarence Center Volunteer Fire Company, Inc. whether the information be of public, private or confidential nature; and 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:


Date: 04/25/2024
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Applicant Signature (click & drag mouse or touchscreen to sign)
Witnessed by:*


Witness Signature
Date: 04/25/2024
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Witness Signature (click & drag mouse or touchscreen to sign)