Jr. Member Application FFC

FRANKLIN FIRE CO.

Junior Membership Application
Applications are reviewed and voted on at the following monthly meeting after submission (1st Tuesdays of the month);you will be expected to attend along with your parents to get the verdict!
TYPE OF MEMBERSHIP APPLYING FOR:*

Jr. Operational: Respond to emergencies & participate in firematic activities, with a potential live-in option availableJr. Operational Support Staff:assist the department through non-emergency duties like fundraising & station support activities
PERSONAL INFORMATION

All sections are required.
Full Name:*
Address:*
Phone Number:*
Email:*
example@example.com
Grade in School*
School You Attend:*
Social Security Number:*
Emergency/Parent Contact Name:*
Emergency/Parent Contact Phone Number:*
Beneficiary:

Each member is required to list a beneficiary that we keep in our records.
Beneficiary Name:*
Beneficiary Relationship:*
Beneficiary Phone Number:*
References:

We may call these references to evaluate your character and to ensure you will be a beneficial part to our organization.
Educational or Departmental Reference Name #1:*
Educational or Departmental Reference Phone Number:*
Educational or Departmental Reference Name:*
Educational or Departmental Reference Phone Number #2:*
ADDITIONAL INFORMATION
Have you been a member of another fire department? If yes where?
Have you ever been charged/convicted of a crime? If yes, please explain:
Why do you want to join the Franklin Fire Company?*
Junior Membership Required Documents:

Applications submitted without the documents listed below will NOT be voted on and will be considered INCOMPLETE- Questions please reach out to join@sta4.com
The following documents must be submitted with the application by all applicants, per PA Commonwealth Labor Laws and the Franklin Fire Company

PA Work Permit

Most Recent Copy of Report Card/Grades

Drivers Licenses if Applicable
Report Card/Grade Upload:*

Cancelof
PA Work Permit Upload *

Cancelof
Drivers License Photo Upload if applicable : *

Cancelof
Disclosure & Release of the Franklin Fire Company
I the applicant and my legal guardian authorize the Franklin Fire Company to conduct any check ins with the legal guardian and applicant along with collection of report cards at any time during my Junior membership. This authorization has no expiration and remains in effect unless revoked in writing.

I and my gurdian understand the results of my grades, conduct, or lack of participation may affect my eligibility, duties, or continued membership and release the Franklin Fire Company, its officers, members, agents, and reporting agencies from all liability.

I certify that all information I provide is true and complete; false or omitted information may result in denial or termination of membership.
Applicant Signature*

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Guardian Signature*

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ANY FALSE INFORMATION OR FAILURE TO COMPLETE THE APPLICATION IN FULL MAY RESULT IN THE TERMINATION OF THE APPLICATION PROCESS.

THE FRANKLIN FIRE COMPANY RESERVES THE RIGHT TO DENY ANY APPLICATION FOR ANY REASON.

BY SIGNING THE APPLICATION, YOU ATTEST THAT ALL INFORMATION LISTED ABOVE IS TRUE TO THE BEST OF YOUR KNOWLEDGE AND THAT APPROVE OF THE $10 NON-REFUNDABLE APPLICATION FEE THAT IS COLLECTED.
Applicant Signature*

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Guardian Signature*

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Should be Empty:

FRANKLIN FIRE CO.

PERSONAL INFORMATION

Beneficiary:

References:

ADDITIONAL INFORMATION

Junior Membership Required Documents:

Disclosure & Release of the Franklin Fire Company