A sample application is available on this page to help illustrate what is expected and serve as a reference tool until you are ready to obtain an actual application. Once ready, you can fill out the “Application Request “ and by clicking “Submit” you can then download the application. Please note that your primary Liaison for admission will be the Board Manager of the County in which you served as a firefighter. All interested applicants are referred to this Board Manager who will then assist you through the process and present the application to the Home for clinical review by the Medical Director, Director of Nursing, Social Service Director and Superintendent.Please note that only applications completed in their entirety will be reviewed. Missing items may result in a delay or the application being returned. For those who prefer an actual hard copy of the application, please contact the Home or the County Manager associated with your Fire Service. DOWNLOAD SAMPLE APPLICATION
Please complete the form below in order to access and download the full Admission Application and Application Instructions.
Important – Please click here regarding Admission Eligibility
Once you are ready to begin the process, please know that application success is really an easy goal to attain. Page 3 of the application serves as your “check off list” and will help you focus on achieving a complete application that is ready to present to your designated Board Manager. It is our recommendation that you first prioritize the medical certification form and typed psychiatric evaluation, as these two items are typically the most time consuming as they are contingent on obtaining physician’s appointments and securing the subsequent reports. These reports are to be done by a physician and psychiatrist of your choosing and must accompany the application. All evaluations must be current (within 6 months of submitting the application and/or reflect the applicant’s current medical condition). If the applicant is currently in a facility, please have the current facility forward information such as daily progress notes, physicians order sheet and other evaluations that may be pertinent for continuity of care to our Social Worker, Ursula Baumgartner @ (973) 334-0024 Ext:22. Once you have addressed the medical piece, it is then a matter of collecting forms. Please use page 3 of the application as your guide.
Page 18, “Report of the Local Fire Company”, needs to be sent to the fire department where the applicant served and signed for subsequent inclusion in the completed application. Throughout the application process, the Board Manager can provide answers to questions you may have or refer you to the appropriate party. Prior to submitting the application document, it is important to ensure ALL the sections of the application are filled out and that the information requested is accurate. This will help to safeguard against any delays in the review process. Once this is accomplished, please contact your Board Manager for their review and signature. Once the manager is confident that the application is complete, the application is sent to the Firemen’s Home Application review committee. The application committee meets monthly and reviews ALL completed applications received. It is important to recognize the application committee reviews the completed applications in the order in which they are received at the Firemen’s Home. It is also important to recognize that a completed application does not guarantee an immediate admittance into the Home.
There are several important factors which ultimately determine if the Firemen’s Home is a match with a potential applicant. Some of these factors include the availability of open rooms and beds; the ability of the Firemen’s Home to meet the Quality of Life needs and the ability of the Home to provide specialized medical care – all factors for determining if the Home can be everything you need it to be – and more.
Before you download the “Sample” application – take the initial step of reaching out to YOUR BOARD MANAGER and let them HELP YOU get started. The overall goal of the application is to ensure the Firemen’s Home can make an educated and informed determination when any applicant is presented for admission.
You can use the Manager’s link to see who your Board Manager is and how to contact him/her. At the Firemen’s Home EVERY APPLICANT MATTERS. It is our responsibility and duty to help you navigate this important step. THANK YOU for thinking of us… we are ALWAYS thinking of you.