Rescue Fire Company Membership Application

Rescue Fire Company Membership Application
Please complete all the information on this application. A $10.00 fee must be attached to this application via cash or check at the time of submission.
Applicants must be no less than 14 years of age. In accordance with PA Child Labor Laws, all applicants 14-18 years of age must provide working papers issued through the school district.

Thank you for your interest in volunteering with our company.
Personal Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
Phone Number*
Format: (000) 000-0000.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
ActiveParticipatingSocial
Employment & History
Current Employer
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor

First NameLast Name
Supervisor Telephone

Area CodePhone Number
Highest Education Level Achieved
Name of Institution
Location of Institution

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Fire / Emergency Services Experience
Basic Requirements
Are you legally entitled to work in the United States?*
Have you ever been convicted of a felony or misdemeanor?*
If yes, please explain
Clearances
Have you completed PSP Criminal History background check?*
To complete the mandatory PSP Criminal History check:

Visit: https://epatch.pa.gov/home
1. Select 'New Volunteer Record Check'
2. Agree to the Terms and Conditions
3. Fill out the information use the following Volunteer Organization:
  Organization Name: Rescue Fire Company 37
  Organization Phone: 717-232-9502
Have you completed PA Child Abuse Clearance background check?*
To complete the mandatory PA Child Abuse Clearance check:

Visit: https://www.compass.dhs.pa.gov/cwis/public/home
1. Create Invidual Account, and follow steps.
2. Login on the same page.
3. Follow the steps, select "VOLUNTEER" at the top for reason requesting the application.
Have you lived outside of Pennsylvania in the past 10 years?*
Required if you have lived outside PA in the past 10 years.

Visit: https://uenroll.identogo.com/
1. Enter service code: 1KG6ZJ
2. Fill out all the information required.
3. Schedule fingerprinting at available locations
There is a fee of $22.60 which must be paid upfront to the vendor. If found favorable, you may submit for reimbursement by the Company.
Please Attach All Clearances OR email applications@rescue37.org OR submit in-person.

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Skills and Experience

Fire Service/EMS or other related training
If applicable skills/experiences do not come with a certification, please explain
Upload Certifications

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References

List two references not related to you
References (Select Add New Reference)
Terms and Conditions
Date

MonthDayYear
Date
Signature
The RESCUE FIRE COMPANY shall not discriminate against any applicant because of
race, religion, national origin, or sex as in accordance with the Civil Rights Act of 1964.
Should be Empty:

Rescue Fire Company Membership Application

Personal Information

Employment & History

Basic Requirements

Clearances

Skills and Experience

References

Terms and Conditions