Bedford Fire Department
Members Area

2018 Incidents
Jan 22 23 7
Feb 30 13 5
Mar 98 15 4
Apr 21 19 4
May 38 27 3
Jun 26 21 11
Jul 44 24 7
Aug 35 21 5
Sep 37 20 1
Total 351 183 47

Past Incidents
2017 366 222 50
2016 389 276
2015 344 263
2014 316 266
2013 346 240
2012 397 234
2011 382 263
2010 429 243

Visitors Today:

Visitors Since
December 1, 2005:

Threat Level

U.S. Department of
Homeland Security

Never Forget

Membership Application

Required   Indicates Required Field
Applicant Information
Last Name: Required
First Name: Required
Middle Initial:
Social Security Number: Required
House Number:
Address: Required
Apt. / Suite Number:
State: Required
Zip Code:
Home Telephone Number:
Mobile Number: Required
E-Mail Address: Required
Date of Application: Required
Can You Commit to a Minimum of 3 Years' Service with the Bedford Village Fire Deptment? : Required
Membership Status
Category to be applied for:
Emergency Contact Information
(EC) Name:
(EC) Address:
(EC) Primary Number:
(EC) Secondary Number:
Relationship to You:
Personal Information
Are You a Citizen of the United States?:
If not, what is Your Residency Status? :
If not a citizen, provide a copy of relevant documentation:
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Do you current possess a driver's license? :
License State:
License Class:
License Number:
License Expiration Date:
Copy of Drivers License:
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Do you have a social networking account (E.g., Facebook, Instagram, Twitter)? If so, please list:
Employment History
Please list your employment history for the last five years. Indicate if you are currently not employed. (Use a separate sheet of paper, if necessary / indicate if you are a full-time student)
(EH) Name:
(EH) Address:
(EH) You're Position:
(EH) Supervisor:
(EH) Phone Number:
(EH) Dates of Employment:
(EH-1) Name:
(EH-1) Address:
(EH-1) You're position:
(EH-1) Supervisor:
(EH-1) Phone Number:
(EH-1) Dates of Emplyoment:
Additional Employments:
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High School :
Did You Graduate High School:
Did You Graduate College:
Did you Graduate Graduate School:
If you are not presently enrolled in college, do you have plans to enroll in a college or university? :
Please Explain:
Military Service
Have You Served in the U.S. Armed Force:
If so, What Branch:
Years of Military Service:
Discharge Status:
Reserve Status:
Did You Receive Special Training that Might be Applied to the Fire Department:
Fire Department Status
Are you now or have you ever been a member of a paid or volunteer fire department or volunteer ambulance service:
If Yes, Which Department:
Years of Service:
Reason for Leaving:
Personal References
Please list three personal references (other than members of the Bedford Village Fire Department) to whom we may inquire as to your character
(PR) Name:
(PR) Address:
(PR) Relationship to You:
(PR) Phone Number:
(PR) E-Mail Address:
(PR-1) Name:
(PR-1) Address:
(PR-1) Relationship to You:
(PR-1) Phone Number:
(PR-1) E-Mail Address:
(PR-2) Name:
(PR-2) Address:
(PR-2) Relationship to You:
(PR-2) Phone Number:
(PR-2) E-Mail Address:
Also list the names of any acquaintances who are members of the Bedford Village Fire Department:
Background Information
Have you ever been convicted of or pled guilty to a felony, misdemeanor, insurance fraud, arson, sexual misconduct, perjury, excluding offenses where the record has been sealed, purged, or where you have been exonerated? :
Are there any criminal charges pending against you? :
Are there any moving violations noted on your current driver's license? :
If you answered "yes" to any of the above, please explain :
Following acceptance of an application for membership to the BVFD, an applicant is required to undergo a physical examination by a physician designated by the District, to determine the applicant's ability to perform the duties of a Firefighter / EMT
If you are accepted for membership will you agree to undergo this examination:
Attached Forms
Affirmation of the Applicant & Authorization for Release of Information Form:
Add files...
Application Status:
Application Status Date:
Click the following to download the Affirmation of the Applicant & Authorization for Release of Information Form

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Bedford Fire Department
34 Village Green
P.O. Box 230
Bedford, New York 10506-0230
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Fax: (914) 234-0625
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