Chalfont Fire Company Membership Application
Directions to applicant:
We are glad that you're interested in joining us at the Chalfont Fire Co. This sheet will explain how to apply for membership and provide a reference for contacting us. Becoming a member takes about two months and only costs one dollar!
Step 1. Fill out this application, attach one dollar and either hand it to a member or mail it to us.
Step 2. Meet with a member of our applications committee.
Step 3. Attend a General Business meeting so you can introduced to the company and be proposed for membership.
Step 4. At the following monthly meeting the membership will vote on acceptance of you as a member.
Some important things to remember:
The Company rules state that you must be present at a Company meeting to be proposed. Meetings are almost always on the first Thursday of each month at 8:00 pm.* If you have a problem or question about anything on the application or anything with the application process, please let us know. You can contact us by calling 215-822-9685 and leaving a message for the application review committee.
Please keep this sheet so you can refer to it later on. If you have questions, just call. We're glad to have you.
*If there is some reason, such as work schedule, that you can not be present to be proposed, please contact Bill Fluck at 215-822-9685 to make arrangements to seek a waver.
Chalfont Fire Company Membership Application
1. Personal Information
Date of Application:______________ Home Phone:_____________________
Name:_________________________________________________________
Home Address:__________________________________________________
__________________________________________________
How Long have you lived at this address? ______Years ______Months
If less than three years, list prior address:
___________________________________________________
___________________________________________________
Work Phone:__________________ Pager:________________________
Fax:_________________________ Email:________________________
Social Security Number:_____________________________________________
Drivers License Number:_________________________ State:_______________
Date of Birth:______________________________________________________
Have you ever been convicted of a crime? YES/NO If YES, explain:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
(If you need additional space, continue on other side)
Have you ever been arrested? YES/NO If YES, explain:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
(If you need additional space, continue on other side)
What areas are you interested in:
______Fire Fighting ______Ambulance
______Fire Police ______General Non-emergency
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2. Employment Information:
Employer:__________________________________________________________
Position:____________________________________________________________
Address:____________________________________________________________
___________________________________________________________________
___________________________________________________________________
Immediate Supervisor:____________________
Phone:_______________________
How long have you worked for this employer? _____Years _____Months
If less than three years, list previous employer below:
Previous Employer:_______________________________________________
Address:_______________________________________________________
Position:___________________________ Dates:_______________________
Immediate Supervisor:______________________ Phone:_________________
Are you legally eligible for employment in the USA? __________________________
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3. Prior Emergency Services Experience
Are you now or were you ever a member of any other emergency services agency?
_______________ If no, skip to Section 4.
Agency Name(s):_____________________________________________________
Positions Held:_______________________________________________________
Address(es): ________________________________________________________
___________________________________________________________________
Supervisors Name:_____________________ Phone:_________________________
Dates of membership:_________________________________________________
Emergency Services Training:
Please list all certifications or licenses. Copies of said certificates and licenses will be required upon acceptance:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
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4. Statement of Understandings and Authorizations
I hereby apply for membership in the Chalfont Chemical Fire Company No. 1 (hereinafter know as the Company) and, if accepted for membership, I will comply with the constitution, bylaws, rules, standard operations procedures, and conduct expected of company members.
I authorize the Company to investigate the statements made in this application. I understand that an investigation of these statements may be made, including but not limited to, a criminal background check and a Bureau of Motor Vehicles records check. I understand that omitting or falsifying information in this application or any subsequent interview connected with this application may result in denial of membership or expulsion from the Company.
I hereby authorize the following parties to release any and all information concerning me to the Officers of the Company, or their agent:
1. Bureau of Motor Vehicles of the Commonwealth of Pennsylvania, or any other state driver's license authority;
2. Any Law enforcement agency;
3. Any emergency services agency I was ever a member of;
4. Any employer, past or present.
I understand that nothing contained in this application or any membership interview is intended to create a contract for employment, a contract providing any benefit, or to in any way obligate the Company. I certify that no promises regarding employment or any other benefit were made to me and I understand that in any event, any such promises are not binding on the Company.
Signature of Applicant:
_____________________________________________ Date:________________
Printed Name:_______________________________________________________
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5. Applications Committee Processing Record
Date application received:______________________________________________
Date of interview:___________________ In person or phone:__________________
Comments:__________________________________________________________
___________________________________________________________________
___________________________________________________________________
Date criminal record check completed:______________ Comments:______________
__________________________________________________________________
Date driver's license checked:_______________ Comments:___________________
__________________________________________________________________
Date applicant proposed:__________________________
Date of membership vote and results:______________________________________