Last First Middle Initial
DOB___/___/20____ S.S.N.______________________ DRIVERS LICENSE #______________________
# Yrs At Above Address________ Occupation__________________________________________________
Employer_________________________ Address__________________________ Phone #_____________
References (List Two) (References may be contacted)
Name__________________________________________________________ Phone #__________________
Name__________________________________________________________ Phone #__________________
ALL APPLICATIONS TO DENNISON TWP. VOLUNTEER FIRE CO. MUST
STANDING AND NOT ON PROBATION.
I am being sponsored by _________________________________ who is a member in good standing of
the Dennison Twp. Volunteer Fire Co. and is currently not on probation.
PLEASE ANSWER ALL THE FOLLOWING QUESTIONS:
1. What type of membership do you desire? Active Fire Fighter___ Fire Police___ Active Member___
2. Do you have previous fire service training or experience? YES_____ NO_____
Name of previous fire company _________________________________________ How Long?_______
COPIES OF ALL TRAINING CERTIFICATES MUST ACCOMPANY THIS APPLICATION
3. Do you currently belong to any other fire company? YES_____ NO_____
If yes, please name __________________________________________________ How long ______
4. Do you own a vehicle? YES_____ NO_____
5. Would you generally be available: Daytimes_____ Evenings_____ Nights_____
6. To the best of your knowledge are you in good health? YES_____ NO_____
(If answering no to the above question please provide details on a separate sheet)
7. Have you ever been arrested for anything other than a minor traffic violation? YES____ NO_____
(If answering yes to questions 7 or 8, please provide details on a separate sheet)
8. Have you ever been convicted of a crime? YES____ NO_____
9. Name and contact phone # of Previous Fire Company (if any)__________________________________
(over)
JUNIOR APPLICANTS ONLY (less than 18 years of age)
1. Are you still in school? YES_____ NO_____
2. Do you have working papers issued by Pennsylvania? YES_____ NO_____
(All juniors MUST have working papers before application can be processed)
WAIVER
ALL APPLICANTS: Please read the following information. No application will be accepted unless the
appropriate signatures are present.
I, ________________________________hereby upon my application do give permission to any member of
the Dennison Twp. Volunteer Fire Co. Membership Committee or said committee’s authorized representative
to conduct whatever investigation is deemed necessary by said committee to affirm that I am of sound mind
and character and of good moral stature. I do understand the reason for the above and agree to release from legal
action or obligation the Dennison Twp. Volunteer Fire Co., the officers and members of said fire dept., the
membership committee of said Fire Co. and furthermore any release of requested information. Upon my
acceptance to the Dennison Twp. Volunteer Fire Co., I agree to uphold and obey said companies constitution
and by-laws.
Signature of Applicant: _________________________________________ Date: ___________________
Signature of Sponsor: ___________________________________________ Date: ___________________
Attention all JUNIOR applicants: Parents or Guardians signatures are required below. If only one (1) signature is
available you must indicate why below the signature lines.
Parent or Guardian: _______________________________________ Date: ___________________
Parent or Guardian: _______________________________________ Date: ___________________
Witness (other than family member): _________________________ Date: ___________________
PLEASE ATTACH A PHOTOCOPY OF YOUR VALID PA DRIVERS’ LISCENCE
wrb 01/06
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