Join Us

Step 1 of 4

What department are you applying to?*

Fire

EMS

Fire & EMS

Name*

Email*

Date of Birth*

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Cell Phone*

Social Security Number*

Driver's License #*

Driver's License State*

Driver License Exp Date*

Certification & Past Experience*

Yes

If yes, please list certifications below

Are you currently or have been a member of another fire department or EMS?

Yes

If yes, please list below the reason for leaving

If available, please upload a PDF copy of all certifications in one file

Max. file size: 200 MB.

Reference 1: Please provide 2 references who are not related to you*

First Name Last Name

Phone*

Reference 2*

First Name Last Name

Phone*

Do you know any current or retired members of the East Rutherford Fire Department or Emergency Squad?*

Yes

If yes, please list member's names*

Have you ever been arrested, charged with or convicted of a felony or misdemeanor?*

Yes

If yes, please explain*

Today's Date*

I hereby knowingly give the East Rutherford Fire Department permission to run a criminal and driver's license background check*

First & Last Name (By digitally signing your full first & last name, you are authorizing permission to East Rutherford Fire Department)

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Phone

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