RIDGE-CULVER FIRE DEPARTMENT

11/25/2017 pg. 1

RIDGE-CULVER FIRE DEPARTMENT Rochester, New York 14622 Phone: (585) 467-4241 Thank you for your interest in becoming a member of the Ridge Culver Fire Department. The Ridge Culver Fire Department was organized in 1921 with the mission to protect lives and property in an area of Irondequoit, NY known as the Ridge Culver Fire District. We are a combination volunteer and career organization who prides themselves on providing quality and professional EMS and fire related services to our residents. We respond to approximately 1900 emergency calls per year. Please review the below information regarding volunteer membership with our organization. If you decide to fill out the application it can be dropped off at the firehouse at 2960 Culver Rd at your convenience. If approved as a new member of our organization, there will be numerous requirements expected of you. New Active Firefighter (Recruit) training is held on Sunday evenings starting at 7pm and lasts 12-16 weeks. We expect you to attend all sessions of recruit training and if you miss more than 3 sessions, you will have to start the program over. In addition, you are also welcome to attend the department wide drills on Thursday nights at 7pm. The department drills are great opportunities to meet the other firefighters, gain additional training and familiarize yourself with the department culture. Once you have passed your recruit class exams and have been approved by the Chief, you will be able to respond to calls on the apparatus within the district. From then on, you will be expected to attend all Thursday night drills to ensure that you are up to date with all of the state and federally mandated yearly training requirements. Within 18 months of becoming a new member, you will also be required to attend the Firefighter I Class within Monroe County or at the NYS Academy of Fire Science in Montour Falls, NY. This course is held two nights a week (either Mon/Wed or Tues/Thurs,) during which you will not be expected to attend department drills. Being well trained is essential to being a good firefighter and reflects positively on the whole department. As an active member of the Ridge Culver Fire District you are required to attend 15% of all fire related calls in order to stay in good standing and to meet the requirements of our retirement program. This equates to approximately 120 calls per year. In addition you are required to attend at least 10 Ridge Culver Fire Association events. These events include association meetings, parades, fundraisers and community service events. The Ridge Culver Volunteer Fire Association is the social arm of the Ridge Culver Fire Department. They are responsible for many events throughout the year from fundraising to annual parties and dinners. They generate money from fundraising and a 2% contribution from the Fire District to be used on membership activities and other expenses. The Ridge Culver Fire Department is governed by the Rules, Regulations, By-Laws, Standard Operating Guidelines and Policies of the Ridge Culver Fire District, Ridge Culver Volunteer Fire Association, Inc. and the Chiefs Office. It is recommended that you become familiar with these after joining as they will guide you in your actions on and off the Fire Ground We hope after reviewing the requirements of being an active member of our organization that you will consider joining the Ridge Culver Fire Department. Being a volunteer firefighter is not only a great way to help in your community but can also be a very rewarding experience. 11/25/2017 pg. 2

FIREFIGHTER/ SOCIAL MEMBER APPLICATION PROCESS 1. Applicants for membership with the Ridge Culver Fire Department must meet the minimum requirements which include being at least 18 years of age, having a diploma or GED and holding a valid NYS driver s license. In addition, active firefighter candidates must live in the Town of Irondequoit or within 1 mile of the fire district boundaries and have no arson or sex offender history. If you meet these requirements and would like to apply, please complete the application and return it the Ridge Culver Fire Department with a copy of your driver s license. 2. Once your application has been received, a New Member Committee liaison will contact you to schedule an appointment for a business style interview and to further discuss new member expectations and your potential membership with the Ridge Culver Fire District or Association. The interview will be with the New Member Committee which includes the Association President, the Fire Chief, a Commissioner, a Career Firefighter and a Volunteer Firefighter. 3. Following the interview, a New Member Committee liaison will contact you to let you know whether you have or have not been recommended for membership. If recommended your application will be forwarded to the Association and your background process will begin. The fire district will complete a background check, a LENS (License Event Notification) check on your driver s license, an arson check and a sex registry list check. In addition your references and employers may be contacted at this time. 4. If your background check is successfully completed, then your approval for membership will be voted on at the next Association Meeting, which is typically held on the last Wednesday of the month. Items 5-8 below are for Active Firefighter Applicants Only 5. If approved for membership by the Association then a representative will contact you with directions on where you can obtain your firefighter physical. 6. Once you have obtained a physical and been cleared for firefighting duties, you will be asked to attend the next meeting of the Ridge Culver Fire District. At this meeting you will be introduced to the board of fire commissioners who will review the Districts Code of Conduct. Following the review, the district will vote on your status with the department. This is the final step in the approval process. 7. If approved by the Board of Fire Commissioners, you will be given paperwork to complete and return to the Fire District Secretary. Please review the documents and return them with the proper signatures and dates. 8. Recruit Training should begin shortly after your approval as a member. You will be contacted by a fire officer for specifics on training and your next steps in becoming a qualified firefighter with the Ridge Culver Fire Department. 11/25/2017 pg. 3

APPLICATION FOR ASSOCIATION MEMBERSHIP NAME DATE OF BIRTH ADDRESS APT. # CITY, STATE ZIP CODE HOME PHONE CELL E-MAIL NUMBER OF YEARS AT PRESENT ADDRESS ANTICIPATED LENGTH OF CONTINUAL RESIDENCY IN RIDGE-CULVER FIRE DISTRICT PLEASE COMPLETE BELOW IF YOU HAVE LIVED ELSEWHERE WITHIN THE LAST FIVE YEARS ADDRESS APT. # CITY, STATE ZIP CODE A RESUME MAY BE INCLUDED IN PLACE OF COMPLETING THE BELOW EMPLOYMENT HISTORY EMPLOYER NAME OCCUPATION ADDRESS PHONE CITY, STATE ZIP CODE YEARS EMPLOYED PREVIOUS EMPLOYER OCCUPATION ADDRESS PHONE CITY, STATE ZIP CODE YEARS EMPLOYED REASON FOR LEAVING 11/25/2017 pg. 4

PLEASE INDICATE HOW YOU HEARD ABOUT VOLUNTEER OPPORTUNITIES AT THE RIDGE CULVER FIRE DEPARTMENT (NEWSPAPER, WEBSITE, OTHER MEMBER OR EXPLORER, ETC) DO YOU POSSESS A VALID NEW YORK STATE DRIVER'S LICENSE? YES or NO IF SO, DESCRIBE ANY RESTRICTIONS DO YOU OWN A MOTOR VEHICLE OR HAVE UNRESTRICTED USE OF ONE? YES or NO HAVE YOU EVER HAD YOUR DRIVER'S LICENSE SUSPENDED OR REVOKED IN ANY STATE? YES or NO IF SO, LIST STATE, DATE AND DETAILS: HAVE YOU EVER BEEN INVOLVED IN AN AUTOMOBILE ACCIDENT (AS DRIVER) THAT INVOLVED INJURY, DEATH, OR PROPERTY DAMAGE EXCEEDING $500.00? YES or NO IF SO, PLEASE DESCRIBE, INCLUDING DATES AND OFFICIAL JUDGMENT OF FAULT. IF ADDITIONAL SPACE IS NEEDED TO ANSWER QUESTIONS, USE SEPARATE SHEET. HAVE YOU EVER BEEN CONVICTED OF A CRIME? (Felony or Misdemeanor) YES or NO PLEASE LIST THREE PERSONAL REFERENCES ( NON-FAMILY ): NAME ADDRESS PHONE RELATIONSHIP LIST PREVIOUS FIREFIGHTING EXPERIENCE: INCLUDE EDUCATIONAL BACKGROUND IN FIREMATICS, FIRST AID TRAINING, MEMBERSHIP IN OTHER FIRE DEPARTMENTS OR FIRE RELATED YOUTH GROUPS 11/25/2017 pg. 5

MEDICAL AUTHORIZATION I,, RESIDING AT, HEREBY AUTHORIZE THE RIDGE- CULVER FIRE DISTRICT TO OBTAIN INFORMATION FROM ANY OF THE DOCTORS LISTED IN MY MEMBERSHIP APPLICATION WITH RESPECT TO MY MENTAL AND PHYSICAL HISTORY AND PRESENT CONDITION. I DO, BY THIS DOCUMENT, HEREBY AUTHORIZE ANY DOCTOR OR HOSPITAL TO RELEASE ANY INFORMATION REGARDING MY MENTAL AND PHYSICAL HEALTH TO THE RIDGE-CULVER FIRE DISTRICT. SIGNATURE DATED 11/25/2017 pg. 6

HEPATITIS B VACCINATION FOR ACTIVE FIREFIGHTERS HEPATITIS B IS AN INFECTION THAT CAN BE TRANSMITTED WHEN THE BLOOD, SEMEN, VAGINAL SECRETIONS, BODY CAVITY FLUIDS, OR ANY BODY FLUIDS CONTAMINATED WITH BLOOD FROM AN INFECTED PERSON GETS SPLASHED INTO YOUR EYES OR MOUTH, OR ONTO YOUR BROKEN OR ABRADED SKIN, OR UNDER YOUR SKIN ( SUCH AS A NEEDLE STICK ). ESTIMATES ARE THAT BETWEEN 1 AND 5 PEOPLE PER THOUSAND IN THE POPULATION ARE ACTIVELY CARRYING THE VIRUS AND CONTAGIOUS AT ANY GIVEN TIME, SO THE RISK OF YOUR GETTING INFECTED IS VERY LOW, BUT THERE IS A RISK. YOUR BEST PROTECTION AGAINST HEPATITIS B IS BY BEING CAREFUL AND BY USING PERSONAL PROTECTIVE EQUIPMENT. YOU CAN ALSO RECEIVE PROTECTION AGAINST HEPATITIS B INFECTION BY RECEIVING A SERIES OF 3 IMMUNIZATIONS. THE SHOTS ARE GIVEN IN YOUR ARM. AFTER THE SERIES IS STARTED, THE SECOND SHOT IS GIVEN ONE MONTH LATER, AND THE THIRD SHOT IS GIVEN FIVE MONTHS AFTER THE SECOND INJECTION. A TITER IS RECOMMENDED ONE MONTH FOLLOWING THE THIRD SHOT. THE IMMUNIZATION IS SAFE, BUT MAY RESULT IN A STIFF OR SORE ARM FOR A FEW DAYS. PER OSHA REGULATIONS, WE MUST OFFER THE VACCINE TO EVERY FIREFIGHTER. SHOULD YOU DECIDE NOT TO RECEIVE THE VACCINE, PLEASE SIGN THE RELEASE FORM ON THE NEXT PAGE. I WOULD LIKE TO RECEIVE THE HEPATITIS B VACCINE AT NO COST YES NO I HAVE ALREADY HAD THE HEPATITIS B VACCINE YES NO SIGNED DATE 11/25/2017 pg. 7

HEPATITIS B VACCINE DECLINATION STATEMENT I UNDERSTAND THAT DUE TO MY OCCUPATIONAL EXPOSURE TO BLOOD OR OTHER POTENTIALLY INFECTIONS MATERIALS, I MAY BE AT RISK OF ACQUIRING HEPATITIS B VIRUS ( HBV ) INFECTION. I HAVE BEEN GIVEN THE OPPORTUNITY TO BE VACCINATED WITH HEPATITIS B VACCINE, AT NO CHARGE TO MYSELF. HOWEVER, I DECLINE HEPATITIS B VACCINATION AT THIS TIME. I UNDERSTAND BY DECLINING THIS VACCINE, I CONTINUE TO BE AT RISK OF ACQUIRING HEPATITIS B, A SERIOUS DISEASE. IF IN THE FUTURE I CONTINUE TO HAVE OCCUPATIONAL EXPOSURE TO BLOOD OR OTHER POTENTIALLY INFECTIOUS MATERIALS AND I WANT TO BE VACCINATED WITH HEPATITIS B VACCINE, I CAN RECEIVE THE VACCINATION SERIES AT NO CHARGE TO ME. FIREFIGHTER NAME (PLEASE PRINT) FIREFIGHTER NUMBER FIREFIGHTER SIGNATURE DATE 11/25/2017 pg. 8

APPLICANT RELEASE FORM IN MAKING APPLICATION TO SERVE AS A VOLUNTEER FOR THE RIDGE-CULVER FIRE DISTRICT, I AUTHORIZE THE RIDGE-CULVER FIRE DISTRICT TO CONDUCT AN INVESTIGATIVE BACKGROUND INQUIRY, INCLUDING PERSONAL AND PROFESSIONAL REFERENCES, CONSUMER CREDIT REPORTS, CRIMINAL CONVICTIONS, AND EDUCATION AND MOTOR VEHICLE RECORDS. THESE REPORTS MAY INCLUDE INFORMATION RELATING TO MY CHARACTER, WORK HABITS, WORK PERFORMANCE, AND EDUCATION, INCLUDING REASONS FOR THE TERMINATION OF MY EMPLOYMENT DURING MY EMPLOYMENT HISTORY. I UNDERSTAND THAT THE RIDGE-CULVER FIRE DISTRICT WILL BE REQUESTING INFORMATION FROM VARIOUS FEDERAL, STATE, AND OTHER AGENCIES WHICH MAINTAIN RECORDS CONCERNING MY PAST ACTIVITIES RELATING TO MY DRIVER, CREDIT, EDUCATION, AND CIVIL LITIGATION EXPERIENCES AND HISTORIES, AS WELL AS CLAIMS INVOLVING ME IN THE FILES OF INSURANCE COMPANIES. I AUTHORIZE ALL PERSONS WHO HAVE INFORMATION RELEVANT TO THIS INVESTIGATION TO DISCLOSE IT TO THE RIDGE-CULVER FIRE DISTRICT OR ITS AGENTS. I FURTHER UNDERSTAND AND AGREE THAT THE RIDGE-CULVER FIRE DISTRICT MAY REQUEST, UPDATE, OR REVIEW THE ABOVE INFORMATION THROUGHOUT THE TERM OF MY EMPLOYMENT. AS SUCH, I HEREBY AUTHORIZE THE RIDGE-CULVER FIRE DISTRICT TO OBTAIN, UPDATE, AND REQUEST THE ABOVE INFORMATION AS IT DEEMS FIT OR NECESSARY THROUGHOUT THE TERM OF MY EMPLOYMENT. I AGREE TO THIS BACKGROUND INVESTIGATION AUTHORIZATION. APPLICANT SIGNATURE DATE DRIVER S LICENSE ID NUMBER SOCIAL SECURITY NUMBER Note: Social Security number is used for screening process only 11/25/2017 pg. 9