PENNDEL FIRE COMPANY #1
CONFIDENTIAL APPLICATION FOR PROBATIONARY MEMBERSHIP
PLEASE PRINT LEGIBLY

Instructions to Applicant: Please complete the following information

Adult Applicants (over 18 years of age) are responsible for securing a Pennsylvania State Police Check and a Pennsylvania Childline Background Check if they've resided in the Commonwealth of Pennsylvania for more than 10 years.  If an applicant has resided in the Commonwealth of Pennsylvania for less than 10 years, they must also provide a copy of the FBI Criminal Background Check which also includes fingerprinting.

The application will not be accepted and processed without the above needed documents attached to the application.

The Trustees of Penndel Fire Company will act as an investigating committee and review all applications for membership. You will be subject to a police background check and child abuse history. Any previous or current fire companies will be contacted and a personal interview will be held with a trustee or trustees. A report will be given to the membership at the next company meeting.
Last Name:___________________________, First Name:___________________________ MI:______
Date of Birth: ___/____/______ S.S.N._________-_______-___________ Drivers License #. __________________
Address:_____________________________________________________________
Home Phone:_______________________ Cell Phone:_____________________ Work Phone:______________________
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Type of Membership applying for (check one):
______ Active Firefighter. _______ Active Fire Police.  _________  Assisting Fire Fighter / Emergency Responder
______ Active Member. _______ Contributing Member
Prior Fire Service: Yes / No (circle one)
If yes:
Name of Department:____________________________________ Yrs. of Service:___________
Previous Chief/President:______________________________ Phone:_______________________________

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Make/Model of Vehicle_____________________  Yr:_____________________________  Registration# _________________________________

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In Case of Emergency:
Name:___________________________ Phone: ________________________________
Address: ________________________________________________________
Member Recommendation (2 required, print name and sign):
1. _______________________________________________________________________________
2. _______________________________________________________________________________
I authorize Penndel Fire Company to run background/child abuse history reports.
If accepted I promise to abide by the constitution and By-Laws of the Penndel Fire Company # 1.
Applicant Signature: _________________________________________ Date: ____/______/__________
Guardian Signature (if under age 18): ___________________________________

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For Trustees Use Only

Working Papers Received:______________ Police Check Received: ______________________
Child Abuse History Report Received: _______________________
Trustee’s Signature: __________________________________________________
Presidents Signature: _________________________________________________
Date of Interview: ______/______/__________
Trustees present: ______________________________________________________
Any Medical conditions or allergies: ______________________________
Notes: ________________________________________________________________________________
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First Reading: _______________________________
Second Reading: _____________________________
Accepted / Rejected (circle one) Date: ____________________________
Vehicle Make: _______________________ Yr. ______________ Registration #: ____________________
Date of Full Membership: ________________________________

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