Somers Volunteer Fire Department
Somers Volunteer Fire Department

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New Member Application v2

Required   Indicates Required Field
Membership type: Required EMS
Fire & EMS
First Name: Required
Last Name: Required
HOME ADDRESS
Street: Required
City: Required
State: Required
Zip Code: Required
MAILING ADDRESS (if different from home)
Street2:
City2:
State2:
Zip Code2:
PERSONAL INFORMATION
Are you 18 or older: Required Yes
No
Date of birth: Required
Social Security Number: Required
Are you a citizen of the USA: Required Yes
No
Email Address: Required
Landline:
Cell Phone: Required
Are you now or have you been a member of another fire department: Required Yes
No
NYS training ID:
If a prior member of another department
FEMA ID:
If a prior member of another department
Height (inches): Required
Eye color: Required
Hair color: Required
EMERGENCY CONTACT INFO
Name - emergency: Required
Address - emergency: Required
Relationship - emergency: Required
Cellphone - emergency: Required
Email - emergency: Required
Landline - emergency:
EDUCATION
High School Name & Address: Required
HS Years completed: Required
HS Year graduated: Required
College/tech school name & Address:
College/tech years completed:
College/tech year graduated:
Other School name & address:
Other school years attended:
Other School year graduated:
Employment (last 5 years)
Present employer name/address/phone:
Present employer position:
Present employer start date:
Present employer supervisor name:
Previous employer name/address/phone:
Previous employer position:
Previous employer start date:
Previous employer end date:
Previous employer supervisor name:
Do you have any objection to the SVFD contacting your current employer: Yes
No
Do you have any objection to the SVFD contacting your previous employer: Yes
No
Military Service
Have you served in the military: Required Yes
No
Branch of military:
Years of service:
Type of discharge: Honorable
Dishonorable
Prior volunteer fire department or ambulance service
Have you ever applied to any volunteer fire department or ambulance corp: Required Yes
No
Which department:
Department's phone number:
Date applied:
Was your application accepted: Yes
No
If rejected, please explain:
Have you ever been a member of a volunteer fire department or ambulance corp: Yes
No
Department name/phone:
Member from date:
Member to date::
Chief's name and Phone:
Other
Arrested for any violation of law: Required Yes
No
Arrest explanation:
Indicted for any violation of law: Required Yes
No
Indicted explanation::
Convicted of any violation of law: Required Yes
No
Conviction explanation:
Drivers license number:
Drivers license state::
Drivers license expiration date::
Drivers license class::
Membership in other clubs and organizations
Club/Org Name & Address 1:
Club/Org Phone 1:
Club/Org supervisor 1:
Club/org join date 1:
Club/org leave date 1 (leave blank if still a member):
Club/Org Name & Address 2:
Club/Org Phone 2:
Club/Org supervisor 2:
Club/org join date 2:
Club/org leave date 2 (leave blank if still a member):
Signatures - your initials will serve as your electronic signature
Please tell us why you want to join the Somers Volunteer Fire Department: Required
I acknowledge and understand that: Required Yes
I declare that: Required Yes
Signature: Required
Parents signature:
If applicant is under 18
References
Guideline1. References may NOT include your spouse or any relative, either by blood or by marriage, husband/wife combinations, or any 2 members of the same family household.
Guideline2. References should be known to applicant for at least 3 years.
Guideline3. Members of the Somers Volunteer Fire Department may not be used as references, but may be included in the space provided.
Reference 1 name and address: Required
Reference 1 phone: Required
Reference 1 - How are you acquainted: Required
Reference 2 name and address: Required
Reference 2 phone: Required
Reference 2 - How are you acquainted: Required
Reference 3 name and address: Required
Reference 3 phone: Required
Reference 3 - How are you acquainted: Required
Additional references:
Timestamp: Required 05/20/2022 2009




2022 incidents
Fire EMS
JAN 54 180
FEB 41 139
MAR 50 149
APR 52 170
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
Total 197 638

2021 Incidents
Fire EMS
JAN 35 201
FEB 41 179
MAR 65 160
APR 42 169
MAY 52 162
JUN 70 192
JUL 96 176
AUG 55 192
SEP 76 161
OCT 54 172
NOV 49 167
DEC 57 220
Total 692 2151

2020 Incidents
Fire EMS
JAN 44 167
FEB 51 148
MAR 40 159
APR 58 162
MAY 48 140
JUN 64 133
JUL 56 168
AUG 173 169
SEP 60 140
OCT 45 162
NOV 54 134
DEC 62 179
Total 755 1861

2019 Incidents
Month Fire EMS
Jan 47 172
Feb 48 150
Mar 48 177
Apr 43 173
May 41 183
Jun 49 158
Jul 64 153
Aug 43 152
Sep 42 175
Oct 50 145
Nov 53 136
Dec 48 221
Total 576 1995

2018 Incidents
Fire EMS
Jan 58 152
Feb 47 153
Mar 177 178
Apr 38 143
May 71 174
Jun 59 172
Jul 62 159
Aug 68 177
Sep 39 178
Oct 52 160
Nov 46 172
Dec 49 169
Total 766 1987

2017 Incidents
Fire EMS
Jan 44 152
Feb 40 140
Mar 39 138
Apr 50 151
May 49 144
Jun 53 119
Jul 62 131
Aug 50 129
Sep 49 158
Oct 57 137
Nov 58 159
Dec 47 178
Total 598 1736

2016 Incidents
Fire EMS
Jan 53 118
Feb 64 126
Mar 30 146
Apr 45 120
May 50 112
Jun 54 142
Jul 49 132
Aug 60 137
Sep 37 160
Oct 55 161
Nov 47 131
Dec 38 154
Total 582 1639

2015 Incidents
Fire EMS
Jan 39 136
Feb 52 149
Mar 50 160
Apr 40 100
May 59 145
Jun 45 116
Jul 57 166
Aug 39 140
Sep 34 151
Oct 44 140
Nov 30 125
Dec 53 160
Total 542 1688

2014 Incidents
Fire EMS
Jan 40 124
Feb 32 121
Mar 40 110
Apr 39 118
May 46 155
Jun 28 147
Jul 54 146
Aug 44 136
Sep 47 139
Oct 48 135
Nov 56 108
Dec 45 143
Total 519 1582

Older Incidents
Fire EMS
2013 472 1588
2012 628 1613
2011 708 1654
2010 525 1562
2009 468 1474
2008 493 1385
2007 519 1339
2006 478 1195
2005 569 1160
2004 533 979
2003 730 706
2002 959 397
Total 7082 15052
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