Rush Fire Department, Inc.
1971 Rush – Mendon Road
Rush, New York 14543-9705
Tel: 585-533-2058 Fax: 585-533-9202
Email:RFDept@rochester.rr.com On the web at: www.rushfd.org
COPY AND PASTE THIS APPLICATION or E-MAIL US AND WE WILL SEND YOU ONE IN WORD FORMAT TO BE SENT BACK TO US BY E-MAIL.
Application for Membership
(First Name) (MI) (Last Name) _________________________________
(Street Address) (Apartment #) (City, State, Zip Code) _____________________
Home Phone: Work Phone: Cell Phone:_______________________________________________
How long at this address? If less than six months, provide prior address below.
(Prior Street Address) (Prior Apartment #) (Prior City, State, Zip Code)
Employer Address, City, State, Zip Code:
May we contact your employer as a reference? (Yes/No)
Do you have a valid New York State Drivers License? (Yes/No)
Please list previous fire, rescue, police, or ambulance agency associations: (Include agency name, address and contact name)
Have you ever been convicted or pled guilty to a felony, misdemeanor, insurance fraud, arson, or a reduction of one of these offenses? Yes/No _________________
If "yes", please give details on a separate page.
OSHA regulations require that you pass a physical examination before becoming an interior structural firefighter. The department's designated physician will provide you with a free medical examination for this purpose.
Privacy Notification The authority to request and confirm personal information about you is found in New York State Executive Law. The information obtained will:
be used to determine your qualifications for the position for which you are applying,
be released to the fire chief and your potential supervisors, and
be maintained in your personnel fiIe (if you become a fire department member) or in our resume' fiIe for six months (if you do not become a fire department member). The Rush Fire District / Rush Fire Department will maintain this information and these files.
e-mail:RFDept@rochester.rr.com On the web at: www.rushfd.org
Applicant's Authorization for Release of Information
In order to confirm the information that I supplied on my application for membership with the Rush Fire Department, I authorize all licensing agencies, educational institutions, law enforcement agencies, present and former employers, and the US military services to disclose their relevant records about me to the Rush Fire Department/Rush Fire District whether that information be of public, private or confidential nature, and I release them from any liability by doing so.
This authorization, in original copy form, shall be valid for this and any future information, reports or updates that may be requested.
I understand that this form will accompany requests for official documents and confirmations of my credentials.
*My signature acknowledges that I have received and reviewed the New Member Applicant Overview attached to this application.
(Applicant Name - Please Print) (Applicant Signature) (Date)
(Witness Name and Title - Please Print) (Witness Signature) (Date)
FIRE DEPARTMENT RECORD OF ACTIONS
Rush Fire Department - New Membership Applicant Overview
The Rush Fire Department is a public safety organization that provides fire, rescue and. emergency services to a diverse community. We are committed to the preservation of life, property and the environment. Through education and public awareness programs, we enhance the quality of life and the safety of the citizens we proudly serve.
Positions available in the Rush Fire Department
Firefighter - This is the primary position for all members of the Department. The firefighter responds to emergencies which threaten the safety of citizens or their property. The firefighter receives basic and advanced training in preparation for emergency response. The firefighter also receives protective clothing and gear suitable for emergency situations. All firefighters also receive training and certification in basic Cardiopulmonary Resuscitation (CPR) techniques.
2. Emergency Medical Services - Firefighters who are interested in Ambulance duty receive additional training and can become certified in New York State as a Certified First Responder (CFR), or as an Emergency Medical Technician (EMT). With this additional training a firefighter can serve the Rush community by assisting residents who become ill or are injured.
3. Fire Police - Firefighters may be called on to provide traffic control or help with management of bystanders during an emergency evolution. The Rush Fire Department provides' the special training required in the state of New York for a person to be sworn in as a Fire Police officer.
4. Rescue Operations - Firefighters may participate in additional training which would qualify them for special roles in auto extrication, water related rescues, remote area related rescues, and rope rescue operations. These special qualifications increase the value that a firefighter brings to the community of Rush and to the Fire' Department.
Requirements - Members are required to complete a Physical Examination, an Orientation to the Rush Fire Department, and attend training programs (drills) offered throughout the month.
Physical Examination is provided by the Rush Fire District.
b. New Member requirements include:
attend at least one drill per month
attend at least two business meetings per quarter
accumulate at least 90 activity points per year, of which 45 must be from response to fire or emergency calls (two points are awarded per call response and per training session; one point is awarded for business meetings, parades, and special details).
Attend all mandatory training
c.Orientation to the Rush Fire Department consists of a program that reviews the Rush Fire District and Rush Fire Department's guidelines for responding to emergencies.
d. Training and Drills include the Monroe County course in the Basics of Firefighting as well as Rush Fire Department's Monday night drills. Drills are held on the 2nd, 3rd, and optionally 4th Mondays of each month. Special drills and seminars are available throughout the year.
Issued Equipment - Members are issued Personal Protective Equipment commensurate with their assigned role. This equipment is intended for the use and safety of all personnel. An inventory of all issued equipment is taken once each year. An alert pager is issued to notify personnel of emergency calls needing a crew for response. Uniforms and jackets are issued for parades or special functions.
Benefits - Members receive benefits listed below.
Each active member is insured under the Volunteer Fireman’s Benefit Law, while on active duty. Additionally, the Rush Fire Department provides coverage under an accident insurance policy.
Group Life Insurance coverage is provided by the Rush Fire District after the new member completes the orientation and physical examination.
Periodic physical examinations are required and provided free of charge by the Fire District.
A physical fitness assessment is provided by the Fire District to all members.
Activities and Other Functions (Include but are not limited to):
1. Monthly Business Meetings: are held on the 1st Monday of the month at 7PM except when a holiday falls on a Monday.
2. Annual Meeting and Election of Social Officers: held on the 1st Monday of December. This is a dinner meeting.
3. Annual Fund Drive: is held in April. Firefighters assist in contacting Rush residents to raise money for the purchase of EMS supplies and for the planned replacement of the Ambulance and Rescue vehicles.
4. Fire Department Carnival: this is another fund raising event held in July. Firefighters are t asked to assist in set-up, operation, and tear-down of the Carnival.
5. Past Officers Banquet: this is a social event held in March of each year. Firefighters are asked to join their comrades for a festive evening. Spouses/significant others are welcome.
Clam Bake: this is a social event held as a celebration of successful Fund Raising activities. The clam bake is held in September and spouses/significant others are welcome.
7. Inspection Dinner: this is a members only social event sponsored by the Rush Fire Commissioners following the annual inventory of issued gear. It is held in November.
8. Parades: these events are held at other Volunteer Fire Departments and communities in the area throughout the spring and summer. Special parade events in the town of Rush include the Memorial Day Parade and the Rush Fire Department Carnival Parade. Firefighters are encouraged to participate.
9. Committees and Sponsored Organizations: there are a number of committees including relief, membership, fire prevention and many others. The sponsored organizations include Cub Scouts, Boy Scouts, Brownies, Girl Scouts and Explorers. It is expected that firefighters participate in committee work.
10. Fire Prevention and Education: The Rush Fire Department conducts special education programs at Monica Leary Elementary School. These programs introduce safety tips for children and acquaint children with Firefighters on a personal basis.
2. Emergency Medical Services - Firefighters who are interested in Ambulance duty receive additional training and can become certified in New York State as a CERTIFIED FIRST RESPONDER (CFR-D), or as an EMERGENCY MEDICAL TECHNICIAN (EMT-D). With this additional training firefighters can serve the Rush community by assisting residents who become ill or are injured.
3. Fire Police - Firefighters may be called on to provide traffic control or help with management of bystanders during an emergency evolution. The Rush Fire Department provides the special training required in the state of New York for a person to be sworn in as a Fire Police officer.
4. Rescue Operations - Firefighters may participate in additional training which would qualify them for special roles in auto extrication, water related rescues, remote area related rescues, and rope rescue operations. These special qualifications increase the value that a firefighter brings to the community of Rush and to the Fire Department.
Rush Fire, Rescue and Ambulance Operations:
a. Orientation to the Rush Fire Department consists of several video tapes and reviews of Rush Fire's guidelines for responding to emergencies.
b. New Member requirements include
(first year requirement)
c. Firefighter Physical Examination is provided by the Rush Fire District. Examination requirements are available from the Rush Fire District secretary.
d. Training and Drills include the NYS Basic course in firefighting as well as Rush Fire Department's Monday night drills. Drills are held on the 2nd, 3rd, and optionally 4th Mondays of each month. Special drills, local, county, regional and state seminars are available throughout the year.
New Membership Applicant Overview:
3. Benefits - Members receive benefits listed below.