Volunteer Form

Membership Type

Regular

Contributing

Junior (Ages 14-17)

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Date of Application

Phone

Date of Birth

Are you a U.S. Citizen?

Yes

PARENT/GUARDIAN

Parent/Guardian Name*

First Last

Parent/Guardian Phone Number*

Parent/Guardian Address*

Street Address Address Line 2 City State ZIP Code

EMPLOYMENT

Occupation

Employer Name

Employer Address

Street Address Address Line 2 City State ZIP Code

Employer Phone Number

Length of time employed at present employer

MEMBERSHIP HISTORY

Have you ever applied for membership of been a member of the Conshohocken Fire Company No. 2 before?

Yes

Are you currently or have you ever been a member of any other Fire Company or Department?

Yes

Do you have any friends or relatives in our Fire Company?

Yes

List 3 References (name & phone and are not directly related to the Fire Company)

NOTICE

A completed application consists of paper application, application fee (cash or check made payable to Conshohocken Fire Company No. 2), Pennsylvania State Background Check, and Pennsylvania Child & Youth clearance. Any person who has lived outside of Pennsylvania within ten (10) years of application date must submit an FBI background check. *Junior Membership applications do not require background checks* Background check links can be located at keepkidssafe.pa.gov/resources/clearances/index.htm Incomplete applications will not be processed until all items are supplied to the fire company

COMPLIANCE

I, the undersigned applicant, respectfully request membership in your company and hereby declare that I have not been expelled from nor rejected by any other fire company, ambulance squad or an alike organization. I am also aware that as a part of the membership process, I am subject to investigative measures conducted by the assigned Investigating Committee. If on inquiry, I should be found worthy, I will conform to the Constitution, By-laws, Rules and Regulations of the Conshohocken Fire Company No. 2.

Signature of Applicant*

Signature of Parent/Guardian*

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Phone

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Volunteer Form

PARENT/GUARDIAN

EMPLOYMENT

MEMBERSHIP HISTORY

NOTICE

COMPLIANCE

Information

Address

Email

Phone

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