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04/07/2025 0418 |
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| Your Personal Information |
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| First Name:
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| Last Name:
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| Middle Name:
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| Date of Birth:
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| Social Security Number:
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| Contact Information |
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| Primary Phone:
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| Primary Phone Type:
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| Secondary Phone:
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| Secondary Phone Type:
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| Email Address:
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| Street Address |
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| Street Address Line 1:
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| Street Address Line 2:
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| City:
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| State:
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| Zip Code:
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| Mailing Address (If Different Than Street Address) |
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| Mailing Address Line 1:
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| Mailing Address Line 2:
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| Mailing Address: City:
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| Mailing Address: State:
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| Mailing Address Zip Code:
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| ID and Criminal History |
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Drivers License:
Upload a clear image of the front of your drivers license.
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Criminal History:
Applicants must not have any felony convictions.
Applicants must not have any misdemeanor convictions in the past five years.
List the date, charge, and circumstances of all criminal convictions.
Failure to disclose all criminal history -- the date and specific charge of all convictions -- will result in automatic disqualification.
If you have never been convicted of a crime, then write "none"
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| Emergency Contact |
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| Emergency Contact Name:
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| Relationship to You:
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| Emergency Contact Phone Number:
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| Emergency Service Questions |
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| Membership Type:
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Previous Experience:
Have you belonged to another emergency service agency? If so, list the agency name, the dates of service, and your reason for leaving. If you do not have previous experience with another agency, then write "none."
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Are you available for training on Thursday nights:
Typically 7 to 9:30 p.m.
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| If no, why are you not available on Thursday nights:
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Are you available for training on Sunday mornings:
Typically 9 to 11 a.m.
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| If no, why are you not available on Sunday mornings:
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| Additional Information |
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Employment History:
Starting with the most-recent, list your past 10 years of employment history. For each , include (1) employer/company name, (2) your position/job title, (3) type of work you performed, (4) the start and end dates of employment, and (5) your reason for leaving. If you do not have any employment history, then write "none."
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| Include any additional information you wish to provide with your application:
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| Acknowledgements |
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| I live within the Wading River Fire District:
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Yes
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| I will be 18 (or older) in the next three months:
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Yes
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I have watched the overview video:
Watch Video Here
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Yes
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| I understand that I will be required to complete the required probationary training (Firefighter 1 or EMT basic course) and all in-house training within the one-year probationary period:
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Yes. I understand and agree.
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| I am to attend all trainings on Thursday nights and Sunday mornings:
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Yes. I understand and agree.
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| I am to notify my company officer in advance whenever I will be unable to attend a training due to an excused absence:
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Yes. I understand and agree.
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| I am to make up all missed required trainings:
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Yes. I understand and agree.
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| I am to respond to all alarms when I am available:
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Yes. I understand and agree.
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| I am to respond to a minimum of 15 percent of alarms annually:
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Yes. I understand and agree.
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| I am to participate in the required number of duty crew shifts per month:
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Yes. I understand and agree.
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| I do not have any felony convictions:
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I so affirm.
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| I do not have any misdemeanor convictions in the past five years:
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I so affirm.
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By submitting this form, I acknowledge that all information provided is truthful and accurate. In addition, I authorize the Wading River Fire Department to conduct a criminal records search and background investigation, which may include, without limitation, requests to federal, state, and local government, police, or law enforcement agencies. Inquiry may also be made through private service bureaus. As part of this investigation, I hereby authorize the Suffolk County Police Department to perform a complete criminal and arrest records check, which will include a sealed records check (arson, DWI, larceny, etc.), and I authorize the release of this information directly to the Wading River Fire Department. I acknowledge the Wading River Fire Department would not consider my application without completion of this release of information. I acknowledge that by providing this authorization, I release the Wading River Fire Department, from any liability in connection with such files. A photocopy of this authorization shall be considered as effective and valid as the original.
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