Membership Application

Use the form below to apply for membership to the Minquas Fire Company No.2. After completing this form, a representative of the membership committee will contact you. In the meantime, feel free to come down and visit the station. If you have any additional questions, please feel free to email recruitment@minquas.org. Remember, no experience required! This form is also not a comitment to membership, our membership team will reach out to you and answer any questions you might have. We look forward to your application and would enjoy the opportunity to welcome you as a member of our team.

Indicates Required Field

Contact Information
Date Submitted:		07/12/2026 0152
First Name:
Last Name:
Date of Birth:
Social Security Number:
Gender:		Male Female
Phone #:
Address 1:
Address 2:
City, State, Zip:
Email Address:
Drivers License Number and Class:
Has your driver's license ever been suspended?:		Select Below Yes No
If your license HAS been suspended please explain the circumstances.:
Education:		High School Diploma/GED Some College < 1 year Some College > 1 year Associate degree Bachelor's degree Master's degree
Occupation- Current Employer:
References (3):
Tell us about yourself:
Have you ever been convicted of a crime?:		Select Below Yes No
If you HAVE been convicted of a crime please describe the circumstances.:
Prior Training
Prior Firefighter Training?:		Yes No
Prior Training:		None Firefighter I Firefighter II EMT Hazardous Materials Operations Vehicle Rescue Technician Water Rescue Awareness Water Rescue Operations Current First Aid, CPR & AED Infectious Control, Bloodborne Pathogens Pump Operations Emergency Vehicle Operators Course NIMS 100 NIMS 200 NIMS 700 NIMS 800
Any other training or experience?:
Membership Type
What type of membership are you applying for?:		Fire Contributing (Ladies Aux, Admin, Support, etc.)
Emergency Contact Information
Name:
Relationship:
Home Phone:
Cellular Phone:
Email: