Thank you for your interest in our department.  Please fill out the following application for membership in the White Mountain Fire Department.  Remember, there is no experience and no residency requirement to join.  We will provide relevant training and certifications.  You will be asked which type of membership you are seeking.  All Hazard Firefighter, Wildland Firefighter only, Emergency Medicine only, or Adjunct.  Adjunct members would fill roles such as fundraising, community event organization, recruitment, maintenance, general support etc.   Some roles will receive compensation.  All members will be covered by workers compensation insurance.

Membership Type (required)Select OneAll Hazard FirefightingWildland FirefighterEmergency Medical OnlyAdjunct Membership

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Personal Information

Last Name (required)

First Name (required)

Physical Address (required)

City (required)

State (required)

Zip Code (required)

Phone Number

Email (required)

Date Of Birth (required)

Do You Have A CurrentDrivers License (required)Select OneYesNo

Driver License Class

A - Commercial Combination

B - Commercial

C - Non Commercial

D - Motorcycle

Commercial Driver License Endorsements (select all that apply)

Air Brakes

Hazardous Materials

Tanker

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Work and School Information

Current Occupation (required)

Employer Name (required)

Are you still in school? (required)Select OneYesNo

Name of School (if applicable)

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Medical Information

Do you have any medical conditions which would limit your ability to perform chosen role? (required)Select OneYesNo

If Yes, Please Explain

Emergency Contact / Relationship

Emergency Contact Phone Number

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Previous Experience

Firefighting Experience? (required)Select OneYesNo

EMS Experience? (required)Select OneYesNo

Certifications? (required)Select OneYesNo

If Yes, Please List Experience and/or Certifications Received

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Criminal Background

Have you ever been convicted of a crime other than a misdemeanor? (required)Select OneYesNo

If Yes, Please Explain

Is there any reason you would not pass a criminal background check? (required)Select OneYesNo

If Yes, Please Explain

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I certify that all statements are true. I understand that any false statements made will be grounds for rejection or dismissal. I agree to abide by the By-Laws and rules of the White Mountain Fire Protection District. Further information such as driver license number and social security number will be required upon application approval.

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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