ONLINE MEMBERSHIP APPLICATION

ONLINE MEMBERSHIP APPLICATION

Marion Volunteer Fire Company
Application Guidelines

Upon submission of your application for membership, several things need to happen before you are approved:

1) Your application will be given to the Membership Investigation Committee, and they contact you for an interview. At the interview we would like to take your picture to be placed in our new member's album.

2) The results of this interview will be submitted to the Executive Board for their approval.

3) If approved by the Executive Board, your application will be presented to the General Membership for a vote. If approved, you will be placed on a 180 day Probationary Membership.

4) At the end of the 180 days you will be voted on again by the general membership for approval into the department as a full member.
Application Instructions

Please fill-out entirely, sign, and hit submit when finished. If you do not receive a "Thank You" message when you submit, please review the application and make sure you have all required fields properly filled-out.

PLEASE NOTE:

1) Out of state residence (other than Maryland): A copy of your FBI clearance form FD-258 must be obtained by the applicant at your expense.

2) If you pass our probationary period and become a regular member you will recieve a reimbursement of $5.00 for your criminal and child abuse checks. Out of state applicants would receive their monies back for the criminal and child abuse check if thay make it through probation.
GENERAL INFORMATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Date of Birth*

MonthDayYear
Date
Age:*
Please enter your age.
Social Security Number:*
Driver's License Number:*
Driver's License issuing State:*
Do you now or have ever been treated for any medical problems, have any back injuries, or any other medical problems that would restrict you in performing any duties related to the Fire and/or Emergency Medical Service?*

NOYES
If YES, please explain:
Are you now or have ever been treated for any Psychological Dysfunctions that would affect your performance with this Department?*

NOYES
If YES, please explain:
Are you currently on, or prescribed any medications that you take on a daily or regular basis?*

NOYES
If YES, please list medications:
Are you now or have been a member of any other Fire and/or EMS departments?*

NOYES
If YES, please list:
Have you ever been expelled or had your membership revoked with any other Fire and/or EMS Departments?*

NOYES
If YES, please explain:
Do you have any Fire or EMS Training, or carry any type of Medical Certifications?*

NOYES
If YES, please list:
PLEASE SUBMIT A COPY OF YOUR CERTIFICATES -OR- BRING COPIES TO YOUR INTERVIEW.
Upload your Certificates (if applicable)

Cancelof
Have you ever been convicted of a misdemeanor, felony, or do you have a DUI conviction on your record?*

NOYES
If YES, please explain:
Personal References

List three personal references that are not related to you and are not a member of a Fire or EMS Department:
Reference 1: Name*

First NameLast Name
City & State*
Phone Number*
Please enter a valid phone number.
Occupation*
Years Known:*
Reference 2: Name

First NameLast Name
City & State
Phone Number
Please enter a valid phone number.
Occupation:
Years Known:
Reference 3: Name

First NameLast Name
City & State
Phone Number
Please enter a valid phone number.
Occupation:
Years Known:
Eligibility for death benefits limited to any members joining this Fire Company on or before their 40th birthday. Who is your beneficiary:
NAME OF BENEFICIARY
Relation to Member:
Please give a brief reason why you wish to join the Marion Volunteer Fire Company and what you have to offer:
My areas of interest/expertise:

Run Fire CallsRun EMS CallsFire PoliceBuilding MaintenanceVehicle MaintenanceGrounds KeepingFundraisingPhotographyComputers/ITSell Games of ChanceWork BingosAccounting/Cash RegistersKitchen/Food PrepHospitality/Auxiliary
Feel free to list any other areas of interest/expertise:
I'd be willing to help with the following events:

Tuesday BingoSeafood FeedGolf TournamentFestivalsAnnual Gun BashKitchen Activities
Marion Volunteer Fire Company Disclosure Policy on Criminal Activity
The Marion Volunteer Fire Company Reserves The Right To Deny Membership To Any Individual That We Feel May Threaten The Safety And The Welfare Of Our Membership.

If you are currently engaged or have been engaged within the past five years, of the following criminal activity(ies), you may be denied membership/employment as it may threaten the health or safety of the members of this fire department.
- A record of conviction for any crime of violence (as that phrase is interpreted under the provisions of the PA Crimes Codes which is graded as a second degree misdemeanor or higher within 10 years of the date of application.) Crimes of violence shall include offenses involving acts or activities with minors where no actual force or threat of force was involved but where the minor was deemed as a matter of law incapable of consent to the activity. An example of the later activity is statutory rape. If you have engaged in such conduct but it did not result in a conviction, the company has the right to deny you membership/employment.
- A record of harassment (as defined in the aforesaid code or in a course of conduct which is a private or public nuisance under civil law) If this conduct was directed at or affected others living within the same household or others living in immediate vicinity to such individuals within a five year period. These provisions shall include but not be limited to unruly, loud, and profane activity arising from the use of alcohol or non-prescription drugs. No applicant shall have engaged in conduct directed toward an elderly person or an individual suffering from a disability including conduct constituting unfair business practices, fraud, deceit and similar offenses of conduct within ten years of the date of application regardless of whether or not such conduct resulted in a conviction.
- A conviction or engagement in a felony act (any conduct deemed a felony under the provisions of the PA Crimes Codes or the PA penal statute within the 5 year period prior to the application) If the conduct is a crime of violence, crime of violence shall include offenses involving acts or activities with minors where no actual force or threat of force was involved but where the minor was deemed as a matter of law incapable of consent to the activity.
- A conviction or engagement involving arson.
Should past conduct prescribed by the above criteria have occurred in another jurisdiction, the conduct involved shall be evaluated on the basis of PA law for similar activities, actions, or convictions; provided; however, that it shall be presumed that a conviction for either a felony offense or a misdemeanor in another jurisdiction will be a disqualifying factor unless an applicant can establish by clear and convincing evidence that the offense is not one that would otherwise disqualify the applicant under these guidelines under Pennsylvania law.
I, First & Last Name , consent that I HAVE NOT been involved in any of the criminal activity(ies) listed above.
I, First & Last Name , consent that I HAVE been involved in any of the criminal activity(ies) listed above.
ACKNOWLEDGMENT
I have read and understand the above guidelines for membership into the Marion Volunteer Fire Company. I understand that my digital signature on this online application authorizes the Marion Volunteer Fire Company Officers, Investigation Committee, or it's designate to complete a background check, as they deem necssary. I furthermore, release all people's requesting or releasing information from all liability from the distribution of such information. I also understand that false or misleading information given could at the discretion of the Executive Board be cause for immediate rejection of my application or dismissal from the company. I certify that all infomation contained herein is true and correct to the best of my ability.
Signature*

Clear
Should be Empty:

ONLINE MEMBERSHIP APPLICATION

GENERAL INFORMATION

Personal References

Marion Volunteer Fire Company Disclosure Policy on Criminal Activity

ACKNOWLEDGMENT