Wayne Fire Department Company#4

1739 Ratzer Road

Wayne, NJ 07470

973-942-7274

Application For Membership

**Must live near 1739 Ratzer Road, Wayne, NJ**

Name:

Email:

Address: Apt:

City: Zip:

Date of Birth: Age:

Home #: Cell #:

Social Security #: Drivers License #:

How long at present address: years

Sex: Male Female

Occupation: Years Employed:

Employer:

Employer's Phone #:

Highest Level of Education:

Referred By:

Please list 2 Personal References:

Name:

Telephone #:

Years Known:

Relationship:

Name:

Telephone #:

Years Known:

Relationship:

Please just fill out this form, print out, and either bring to the firehouse or mail it to:

Wayne Fire Department Company#4
1739 Ratzer Road
Wayne, NJ 07470
Attn: Anthony Falzo

Questions or comments? Contact Us

[History][Apparatus][Prevention][Photos][Membership][Hall Rental][Donations][Links][Contact Us]

info@waynenjfireco4.com

Wayne Fire Department Company#4

Application For Membership

Email:

Address: Apt:

City: Zip:

Home #: Cell #:

Social Security #: Drivers License #:

How long at present address: years

Sex: Male Female

Occupation: Years Employed:

Employer:

Employer's Phone #:

Highest Level of Education: High School Enrolled High School GED High School Diploma College Enrolled College Degree Technical/Professional Degree

Referred By:

Please list 2 Personal References:

Name:

Telephone #:

Years Known:

Relationship:

Name:

Telephone #:

Years Known:

Relationship:

Highest Level of Education: