Membership Application

Use the form below to apply for membership to the Selden Fire Department. After completing this form, a representative of the membership committee will contact you. In the meantime, feel free to browse our website and see what the Selden Fire Department is about.

Member (Fire or EMS) – Membership is open to all persons 18 and older. Members participate in all firefighting/EMS activities (i.e. – responds to emergency incidents, participates in training, assist with fund raising and performs fire prevention activities.)

EMS Squad Member - Squad Members are required to complete 6 in house duty-crews a month and are not held to a point requirement. These members will participate in the same functions as the members listed above.

Juniors – open to all persons 14 – 17 years old. Junior Members partake in training, assist with fund raising and performs fire prevention activities. (Click Here for the Junior Application Form)

Ladies Auxiliary - Ladies Auxiliary is open to the wives, sisters, and daughters of active members of the Selden Fire Department. Ladies Members assist in fund raising, fire prevention and other non-emergency activities hosted by the department. (Click Here for the Ladies Application Form)

Indicates Required Field

Demographics

Membership Type Required

Please describe why you would like to join the Selden Fire Department Required

The Selden Fire Department is always looking to improve our outreach and connect with more members of our community. Please share how you heard about us and what inspired you to apply for membership.

Last Name

Middle Initial Required

First Name Required

Date of Birth Required

Length of time in Selden

Street Address Required

Apt/Unit #

City, State, Zip Required

Email Address Required

Cell Phone Required

Date Available

Membership Questions

Are you legally authorized to work in the United States? Required

Yes No

(Work Authorization) If NO ,explain?

Do you have a NYS Drivers License? Required

Yes No

(Drivers License) If NO ,explain?

Have you ever Volunteered at Selden FD? Required

Yes No

If yes, when?

Have you ever been a member at a Fire Dept or Ambulance Corp.? Required

Yes No

(Member of Other Department)If yes, explain?

Have you ever been Dismissed or rejected from a Fire Dept or Ambulance Corp?

Yes No

(Dismissed)If yes, explain?

Do you currently hold membership to any organizations Required

Yes No

(Org Membership) If yes, explain?

Do you have firefighting or EMS experience? Required

Yes No

(Experience) If yes, explain?

Have you ever been convicted of a misdemeanor or felony? Required

Yes No

(Conviction) If yes, explain?

Are there any charges pending against you? Required

Yes No

(Charges) If yes, explain?

Do you currently hold any certifications? Required

Yes No

(Certification) If yes, explain?

Are you employed? Required

Yes No

(Employer) If YES, Where?

Education

High School Required

(High School) Did you Graduate? Required

Yes No

College

(College) Did you Graduate?

Yes No

Diploma

Other Education

(Other Ed.) Did you Graduate?

Yes No

Reference 1

Reference 1 - Full Name Required

Reference 1 - Relationship Required

Reference 1 - Company

Reference 1 - Phone Number Required

Reference 1 - Address

Reference 1 - Email Required

Reference 2

Reference 2 - Full Name Required

Reference 2 - Relationship Required

Reference 2 - Company

Reference 2 - Phone Number Required

Reference 2 - Address

Reference 2 - Email Required

Reference 3

Reference 3 - Full Name

Reference 3 - Relationship

Reference 3 - Company

Reference 3 - Phone Number

Reference 3 - Address

Reference 3 - Email

Previous Employment

(Previous Employment) - Company

(Previous Employment) - Phone Number

(Previous Employment) - Address

(Previous Employment) - Supervisor

(Previous Employment) - Job Title

(Previous Employment) - Start Date

(Previous Employment) - End Date

(Previous Employment) - Responsibilities

May we contact your previous supervisor for a reference?

Yes No

Military Service

Branch

(Date of Service) From

(Date of Service) To

Rank at discharge:

Type of discharge

If other than honorable, explain:

Disclaimer and Signature

PLEASE COMPLETE FORMS STEP 1 OF APP AND DROP OFF

IN ORDER FOR APPLICATION TO OFFICIALLY BE STARTED, YOU MUST PRINT ATTACHED FORMS ( SEE TOP OF APPLICATION) AND BRING TO FIREHOUSE COMPLETED WITH COPY OF LICENSE.

Yes, I understand

Background Check Consent

Acknowledgement of Background Consent Form if under the age of 18 at the time of application submission

I am over the age of 18. I am under the age of 18 and will have consent form completed by a parent/guardian.

Signature

I affirm that all statements made by me on this form, including attached papers, are true, complete and correct to the best of my knowledge. I understand all statements made by me in connection with this application are subject to investigation and verification and that falsification or omission of information is cause for the revocation of my application for membership or dismissal from membership in the Fire Department. I hereby authorize any former or current employer, volunteer fire department, company, or district I was a member, military records center, or school to provide the Selden Fire Department any and all information necessary to reach a decision on my application. **Please Type your name in the field provided as an electronic signature acknowledging the above.

Electronic Signature Required

By selecting the “I agree” button, I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By selecting “I agree” using any device, means, or action, I consent to the legally binding terms and conditions of this document. I further agree that my signature on this document is as valid as if I signed the document in writing. I am also confirming that I am authorized to enter into this Agreement. If I am signing this document on behalf of a minor, I represent and warrant that I am the minor’s parent or legal guardian. I may decline to electronically sign this document and withdraw my consent to sign this document electronically by contacting the signature requestor directly, which may delay transactions. I may contact the signature requestor separately to request to sign this document on paper or to receive a paper copy of the signed document. Any fees for such paper copy will be charged then by the signature requestor. When I sign the document, I will receive a copy of this document via email.

I Agree

Date

10/12/2026 1958

Qualified applicants are considered without regard to age, race, creed, color, national origin, sexual orientation, military status, sex, disability, predisposing genetic characteristics, marital status, domestic violence victim status, carrier status, gender identity, or prior conviction records, or prior arrests, youthful offender adjudications, or sealed records, unless based upon a bona fide occupation qualification or other exception.

***If the applicant is under the age of 18 years old, the application will be accepted and processed; however, the applicant's formal swearing into the department will not occur until the applicant's 18th birthday, and all documents will be required to be re-signed by the applicant after his or her 18th birthday.

Become a Volunteer!

Step 2 : Complete the attached paperwork to bring to the firehouse for processing! YOUR APPLICATION DOES NOT BEGIN UNTIL THE PAPERWORK AND A COPY OF LICENSE ARE RECIEVED! Click link directly below!!!