Volunteer Fire Company Application

Volunteer Fire Company Application

Volunteer Fire Company Application Form Preview
Application
  • Hershey Volunteer Fire Company

    Membership Application

    • A. General Information  
    • General Information

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    • B. Education History  
    • Education History

    • C. Work History  
    • Work History

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    • D. Prior Residences  
    • Prior Residences for 10 years

    • E. References  
    • 1. List your References

    • Please list three persons who are not related to you and who have definite knowledge of your qualifications or fitness for membership. Do not use names of supervisors you listed above as we consider them references, unless otherwise noted.

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    • 2. Criminal History

    • 3. Medications

    • F. Certification  
    • I affirm that the information contained in this application is true and correct to the best of myknowledge, information, and belief. If I am accepted into membership, I understand that I may berequired to undergo a medical examination as necessary to determine my fitness for duty. I realizethat any falsification in this application constitutes grounds for rejection or termination frommembership. In this regard, and unless I have indicated otherwise below, I authorize my present andpast employers to cooperate with the Hershey Volunteer Fire Company through its membershipcommittee and to release, on a confidential basis, any information regarding my employment7records. I understand that all of the information given will be considered in reviewing myapplication and is subject to investigation. If accepted for membership, I agree to abide by theHershey Volunteer Fire Company By-Laws and any rules and regulations which may apply. I furtherunderstand that my membership may be terminated at any time for any reason as provided by theHershey Volunteer Fire Company By-Laws, rules and regulations.

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    • G. Authorization for Release of Information  
    • I authorize the Hersey Volunteer Fire Company to conduct an investigation into my background, including but not limited to anyrecord of Criminal Arrests which may exist, and to the release to the Hershey Volunteer Fire Companyany and all information obtained as a result of such investigation.

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    • I further understand that this investigation will be confidential and findings contrary to theinformation provided on the application may subject me to prosecution under the Pennsylvania crimescode for unsworn falsifications (18 PA. C.S. §4904). I understand that the information will be released tothe appropriate officers of the Hershey Volunteer Fire Company when the investigation is completed.

      I verify that the information setforth in this application is true and correct. I understand that any falsification contained in this application shallresult in denial or termination of membership. This verification is made subject to the penalties ofsection 4904 of the crimes code of Pennsylvania(18 PA. C.S. §4904) Relating to unsworn falsifications.

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    • H. Resume Upload/Finish  
    • Upload a File
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