I hereby apply for membership in the Chalfont Chemical Fire Company No. 1, herein known as the the Company, and, if accepted for membership, I will comply with the constitution, bylaws, rules, standard operating 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 made to me and I understand that in any event, any such promises are not binding on the Company.
I acknowledge in the event of an injury, my remedy against the Chalfont Fire Company may be limited to a claim of Worker's Compensation.
In accordance with the ESIGN Act of 2000, this application was completed and signed electronically; I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.