Become a Volunteer

Please note: From time to time there have been issues with our automatic form submission. If you submit a membership form and are not contacted within 7 days, please call the Membership Chair, Jerry Adams, @ 585-746-2052. Also you can email either president@walworthfd.org or membership@walworthfd.org to check on your status.

Become A Volunteer

Thank you for your interest to join the Walworth Fire Department! We are always looking for new volunteers. No worries, we provide all of the training.

Type of Membership

Firefighter

Auxiliary

Support

Name

First Name

Last Name

Address

City

State/Province

Zip/Postal

Country

Phone

How long have you resided at the above address (Years / Months)?

Are you at least 18 years old?

Do you have a valid NYS Driver License?

If Yes, a copy is required for NYS LENS Program.

Are you available weekdays (Check all that apply)

Days

Evenings

Nights

Are you available weekends (Check all that apply)

Days

Evenings

Nights

Are you currently a student?

If Yes, please provide name of school

Are you currently employed?

Company Name

Company Address

Company Telephone

Have you ever changed your name?

If Yes, please provide any assumed name or nickname

If you have previous Emergency Service experience, please provide Department, Contact Person, and Telephone # (include only Fire, Rescue, EMS, and Police agencies)

Please list the names of any acquaintances that are members of this agency

Have you ever been a member of the United States Armed Forces?

If Yes, please provide service branch

If Yes, did you receive a dishonorable discharge?

Have you ever been convicted or pled guilty to a felony, misdemeanor, insurance fraud, arson, or a reduction of one of these offenses?

If Yes, please explain

Dishonorable discharge and/or a criminal background is not an absolute denial to membership. This and other factors will effect a final membership decision.

Please list three personal references who have known you for at least 3 years (please include name, address, and telephone number)

Reference #1

Reference #2

Reference #3

Date Approved by District

Thank you for your interest in becoming a member of the Walworth Fire Department. After we receive your application, we will be in contact to schedule an interview.

Note: Walworth Fire District No. 1 requires that you pass (1) a physical examination, (2) a NYS LENS Program check, (3) an arson background check, and (4) a sex offender background check prior to being granted probationary membership. If you are not contacted by us within one week of submitting you application, please call our Membership Chair, Bob Seaman @ 305-495-6364 to check your application status.

If you are human, leave this field blank.

Become a Volunteer

If Yes, a copy is required for NYS LENS Program.

Contact Information

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