GFD 18+ Firefighter Application

GFD 18+ Firefighter Application

Ages 18+ | Updated 2026/01/26
Instructions for Applicants

Please read carefully and complete all required steps before submitting your application. Incomplete applications will be returned.
Steps to Complete Your Application
1. Complete ALL pages of the Application.

2. Apply for and obtain BOTH clearances:
1. PA State Police Criminal Record Check (Form SP4-164A) or apply online at: http://epatch.state.pa.us/Home.jsp
2. PA Child Abuse History Clearance (Form CY-113 attached) or apply online at: http://www.compass.state.pa.us/CWIS
  NOTE: Fees for clearances are waived for volunteers.
Application Checklist

Before submitting, confirm that you have included the following:
☐ Application
☐ PA State Police Criminal Record Check
☐ PA Child Abuse History Clearance
☐ Arson Affidavit
☐ Drug-Free Workplace Policy
☐ Anti-Discrimination/Harassment Policy
☐ Photocopy of Operator’s License or State Photo ID

⚠Reminder: Applications missing any required documents will be returned.
Processing:
• After review, the application will be turned over to the GFD Board of Control.
• The Board of Control will process the application and notify the President of the Fire Company.
• The Company will act upon the applicant.
• Once accepted by the Company, the applicant will be instructed to contact the
Recruitment Coordinator to complete the physical exam and bloodwork.
• Upon successful completion, the applicant will be officially accepted into the
Greensburg Fire Department.

A NEW FIRE GROUND SUPPORT MEMBER - New Members will have ONE
(1) YEAR from company acceptance date to complete the following courses:
1. Introduction to the Fire Service (ELIS) 16 hours
2. HAZMAT Awareness Level (HMAJB) 4 hours
3. Fire Ground Support (ELFG) 32 hours
  TOTAL HOURS: 52 hours
(See course descriptions on a following page)
NOTE: Based on course availability, ANY firefighter may advance to INTERIOR FIREFIGHTER status at any time.

NEW INTERIOR FIREFIGHTER - New Members will have ONE (1) YEAR from
company acceptance date to complete the following courses:
1. Introduction to the Fire Service (ELIS) 16 hours
2. HAZMAT Awareness Level (HMAJB ) 4 hours
3. Fire Ground Support (ELFG) 32 hours
4. Exterior Firefighter (ELEF) 72 hours
5. HAZMAT Operations Level (HMOJB) 24 hours
6. Interior Firefighter (ELIF) 48 hours
  TOTAL HOURS: 196 hour
(See course descriptions on a following page)

RESERVE – MEMBERSHIP (Chief’s Approval ONLY)
Based on the information above, I am applying for:*

Exterior Support PersonnelInterior FFI PersonnelReserve (Pending Chief's Approval)

Applicant General Information
Full Government Name*

First NameMiddle NameLast NameSuffix
Date Of Birth*

MonthDayYear
Date
Age*
Address*

Street Address

Apartment/Suite/Duplex

CityState

Zip Code
Cell Phone*
Please enter a valid phone number.
Email
example@example.com
Driver's License or Photo ID State (if applicable)
Driver's License or Photo ID Number (if applicable)
Emergency Contact Information
Full Name*

First NameLast Name
Emergency Contact Relationship*
Emergency Contact Phone Number
Please enter a valid phone number.
Emergency Contact Email
example@example.com

References

(List three references who may be contacted.)
- Current Employer*
- Occupation*
- Supervisor Name*
  
  First NameLast Name
- Supervisor Phone Number*
  Please enter a valid phone number.
- Occupation Start Date*
  
  MonthDayYear
  Date
- Reference 1 Name*
  
  First NameLast Name
- Reference 1 Relationship*
- Reference 1 Address
  
  Street Address
  
  Apartment/Suite/Duplex
  
  CityState
  
  Zip Code
- Reference 1 Phone Number*
  Please enter a valid phone number.
- Reference 1 Email
  example@example.com
- Reference 2 Name*
  
  First NameLast Name
- Reference 2 Relationship*
- Reference 2 Address
  
  Street Address
  
  Apartment/Suite/Duplex
  
  CityState
  
  Zip Code
- Reference 2 Phone Number*
  Please enter a valid phone number.
- Reference 2 Email
  example@example.com
- Reference 3 Name*
  
  First NameLast Name
- Reference 3 Relationship*
- Reference 3 Address
  
  Street Address
  
  Apartment/Suite/Duplex
  
  CityState
  
  Zip Code
- Reference 3 Phone Number*
  Please enter a valid phone number.
- Reference 3 Email
  example@example.com

Are you a LIFE MEMBER of any fire company or fire department?*

YesNo
Fire Service History | List all previous fire departments you belonged to (if any). Include a supervisor name and contact number.
For each fire department you left or ended your membership, please state the reason for leaving.
Criminal History

Have you ever been convicted of a crime? If yes, provide details for each conviction
Include State, charge, and the disposition.
Do you have any certifications including any State, National, or Pro-Board Fire Service Certificates?*

YesNo
Do you have any physical or emotional limitations that would limit or prohibit you from performing the NFPA-defined duties and functions of a structural firefighter or emergency vehicle operator?*

YesNo
If yes to physical or emotional limitations, please explain.
Terms & Conditions

I, the undersigned applicant, swear and affirm that the information provided in this application is true and correct. I consent to any inquiries, background checks, or investigations necessary to verify the accuracy of the information provided. I understand that omissions or false statements may disqualify me from membership or result in dismissal and/or criminal charges.
Signature*

Powered by Jotform SignClear
Typed Name*
Date*

MonthDayYear
Date

Upload the front and back of your most recent photo ID or Driver's License. *

Cancelof
Upload any previous fire service certifications as listed above. *

Cancelof

Fire Ground Support & Interior Firefighter Class Outlines

Under construction.

These classes are changing by the State Fire Academy and will be updated soon.

Policy Sign Offs
Drug-Free Workplace Policy
The Federal Drug-Free Workplace Act became effective March 18, 1989. The following policy is instituted for the purpose of bringing the policies of Greensburg Volunteer Fire Department and its Companies into compliance with that law.

The unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance by the any Member/Volunteer on the premises of the City of Greensburg, the Greensburg Volunteer Fire Department and its companies or during any activity conducted, sponsored, or authorized by or on behalf of the Greensburg Volunteer Fire Department and its Companies is prohibited.

As a condition of membership, each Member/Volunteer must agree to:
1) Abide by the above statement; and
2) Notify the Board of Control and the Department Chief in writing of any criminal drug statute conviction for a violation occurring on the premises of the Greensburg Volunteer Fire Department, the City of Greensburg, or their Companies, or during a
Department/Company/City sponsored activity within five (5) days after the conviction.

Any Member/Volunteer found to be in violation of this drug abuse policy, at the discretion of the Greensburg Volunteer Fire Department, may be given leave or suspended, without any privileges or benefits, and, required to enter a drug rehabilitation program at the Member’s expense, or the Member/Volunteer may be terminated.

From time-to-time the Greensburg Volunteer Fire Department or its Relief Association may sponsor a workshop for the Members/Volunteers on the dangers of drug abuse. The Department’s ‘Infectious Control Officers’ have been designated as the contact person(s) of any Member/Volunteer who needs a referral to drug counseling or rehabilitation.
ARSON – AFFIDAVIT
I, the applicant, of the address above, hereby swear (and/or affirm), under the penalty of perjury or false swearing, that I have never been convicted, pleaded nolo contendere, or been found guilty of the following:

1) The crime of arson or its related offenses. I have read the definition of “Arson and related offenses” under 18 PA. C.S. §3301 (which is attached hereto as Exhibit "A"). I hereby swear that I have never committed, nor engaged in any of the acts defined or described in this section.

2) The crime of false alarms to public safety agencies. I have read the definition of “False Alarms to Agencies of Public Safety” as set forth in Section 4905 of the Crimes Code (18 PA. CS § 4905), which is attached hereto as Exhibit “B”, and I hereby swear that I have never committed nor engaged in any of the acts defined or described in this section.

I agree and consent to a background check on me at any time.

I understand that if subsequent investigation reveals that I have falsified or otherwise misrepresented the true nature of any criminal offenses that involve myself, I agree to the automatic termination of my Membership in the Greensburg Volunteer Fire Company and Department and to be subject to the criminal penalties for perjury or false swearing herein subject to the penalties of 18 PA C.S.A. Section 4904 relating to unsworn falsification to authorities.

I have attached a copy of my Driver’s License.

I hereby certify that the statements contained herein are true and correct to the best of my knowledge and belief. I understand that if I knowingly make false statement herein, I am subject to penalties prescribed at Law including, but not limited to, a fine of at least $1,000.00.

I swear to the truth of the statements made herein: and fully intend to be bound hereby, by affixing my name to this document.
Anti-Discrimination/Harassment Policy
PURPOSE:
The purpose of this Policy is to clearly establish that the Greensburg Volunteer Fire Department of the City of Greensburg is committed to providing a positive and family-oriented work and social environment free from harassment and/or discrimination.

POLICY:
1) Any harassment or discrimination by a member, a visitor, or a vendor, on the basis of race, religion, national origin, ancestry, disability, medical condition, marital status, pregnancy, sexual orientation, gender, or age is explicitly a violation of State and/or Federal Law; and, such conduct will not be tolerated by the Greensburg Volunteer Fire Department or its Companies. Violations shall be subject to investigation and appropriate disciplinary action, including, but not limited to, discipline or termination from membership.

2) It is the responsibility of all Greensburg Volunteer Fire Department’s Administrative and Fire Operations Officers to enforce this policy.

3) Complaints shall be brought directly to the Department Chief, and his designated Administrative Officer(s).

4) It is the responsibility of each and every Fire Department Member/Volunteer/Worker to know this Policy and to follow this Policy. [See Greensburg Volunteer Fire Department SOG Section 802.]

5) Failure to advise of any observed or reported inappropriate or offensive interaction/relationship is in violation of this Policy. The Department/Company Officer (s) receiving such information shall immediately contact the President and Captain of said Company and/or the Department Chief and inform them of this incident/relationship.

6) False reports shall result in discipline.
By signing below,

you verify that the Applicant and Parent/Guardian both have read, understand, and agree to the Department “Anti-Discrimination/Harassment Policy”, "Arson - Affidavit" and the "Drug Free Workplace Policy".
Applicant Name*

First NameLast Name
Applicant Signature*

Powered by Jotform SignClear
Date Signed*

MonthDayYear
Date
What's Next:
If you wish to do so, you may print this form now using the buttons below.

We will process your application and be in contact. Good luck, we look forward to working with you.
Should be Empty:

GFD 18+ Firefighter Application

Instructions for Applicants

Application Checklist

Applicant General Information

Emergency Contact Information

References

Criminal History

Terms & Conditions

Fire Ground Support & Interior Firefighter Class Outlines

Policy Sign Offs

Drug-Free Workplace Policy

ARSON – AFFIDAVIT

Anti-Discrimination/Harassment Policy

By signing below,

What's Next: