How To Join The Box 54 Club Probationary Membership Required

How to Join the Box 54 Club

Here are the procedures and requirements for becoming
one of the Box 54 Club's active members.

Box 54 Logo

Box 54 Club membership

Prospective members are required to be 18 years of age. Hold a valid driver's license. Serve a 9 month probationary period before becoming an "Active" member. During the "Probationary" period, the prospective members must attend a 3 hour Rehab course given by the Club.

Please copy and paste the text below to
your favorite word processor for printing.
Then fill out and mail in a signed copy to
the address on the form.

Township of Teaneck, New Jersey
                         Office of Emergency Management
                                        &
                       Teaneck Fire Department, Box 54 Club

NAME: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
       ADDRESS: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
          TOWN: _ _ _ _ _ _ _ _ _ _ _ _          ZIP: _ _ _ _ _ _ _ _ _ _ _ _ _ 
    HOME PHONE: _ _ _ _ _ _ _ _ _ _ _ _   CELL PHONE: _ _ _ _ _ _ _ _ _ _ _ _ _ 
         PAGER: _ _ _ _ _ _ _ _ _ _ _ _   BUS. PHONE: _ _ _ _ _ _ _ _ _ _ _ _ _ 
E-MAIL ADDRESS: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
PLACE OF BIRTH: _ _ _ _ _ _  SEX: _ _ _ EYE COLOR: _ _ _ _  HAIR COLOR: _ _ _ _ 
   SOC. SEC. #: _ _ _ _ _ _ _ _ _   DRIVER LIC. STATE #: _ _ _ _ _ _ _ _ _ _ _ _
Do you suffer from any medical conditions?: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
If yes, please list condition and/medication: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

-****-

Did you serve in the armed forces?: _ _  If yes, Branch: _ _ _ _ Rank: _ _ _ _ _
Have you ever been arrested?: _ _ _ _ _  If yes, reason: _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
Do you belong to other volunteer groups that might benefit our organization?: _ 
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
List any education/experience/talents that might benefit Box 54: _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
What is your present occupation and general working hours?: _ _ _ _ _ _ _ _ _ _ 
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
What are your reasons for wanting to join Box 54?: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

List three references that may be contacted
NAME: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ PHONE: _ _ _ _ _ _ _ _ _ _ _ _ _ _
NAME: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ PHONE: _ _ _ _ _ _ _ _ _ _ _ _ _ _
NAME: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ PHONE: _ _ _ _ _ _ _ _ _ _ _ _ _ _
Signature of applicant: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date: _ _ _ _ _ _ _ _ _ 
Applicant interviewed by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date: _ _ _ _ _ _ _ _ _ 
Remarks: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
Date probation began: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date: _ _ _ _ _ _ _ _ _ 
Badge #: _ _ _ _ _ _ _ _ _ _   Plectron Ser.: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
Car shield issued: _ _ _ _ _ _ _ _  Room Key: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
List any other items issued to member: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
Signed by officer in charge: _ _ _ _ _ _ _ _ _ _ _ _ _  Date: _ _ _ _ _ _ _ _ _

Monthly participation:  
                     (R=Run     M=Meeting   G=General)
             January: _ _ _ _ _ _ _ _ _  February: _ _ _ _ _ _ _ _ _ 
               March: _ _ _ _ _ _ _ _ _     April: _ _ _ _ _ _ _ _ _ 
                 May: _ _ _ _ _ _ _ _ _      June: _ _ _ _ _ _ _ _ _ 
                July: _ _ _ _ _ _ _ _ _    August: _ _ _ _ _ _ _ _ _ 
           September: _ _ _ _ _ _ _ _ _   October: _ _ _ _ _ _ _ _ _ 
            November: _ _ _ _ _ _ _ _ _  December: _ _ _ _ _ _ _ _ _

A word of welcome from the Unit Chief!

"The Box 54 Club welcomes any person male or female who would have an interest in providing Rehab at all major fire and disaster scenes in the area. It would be to the applicants advantage to live within reasonable distance from Teaneck Fire Headquarters even though we have no boundary limits. After your probationary period has concluded and based on your run activity, we provide a clothing allowance. All are welcome to come and visit us any Monday or Friday evening for a tour and perhaps an application if you are interested."

Created 4:04 PM 3/4/01

Justin Mattes
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Eric A. Arnold
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Last Modified on: 5:08 PM 2/18/2006