Which type of member would you like to apply?
Full Membership: must be 18 years old and requires a Criminal Record Check.
Junior Membership: must be between 14 and 18 years old and must have working papers.
Associate Membership: individuals who wish to help with Fund Raising projects. |
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First Name
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Middle Name
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Last Name
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Age
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Address
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City
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State
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Zip Code
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Date of Birth
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Social Security Number
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Phone Number
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Mobile Phone
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Drivers License Number
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Class
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Expiration Date
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License State
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CDL License
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Occupation
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Employer Name
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Employer Phone Number
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Employed Since
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Employer Address
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Employer City
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Employer State
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Employer Zip Code
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If you have had previous Fire Company or Ambulance experience, enter it below
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Name of Company
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Non-Emergency Number
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Address
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City
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State
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Zip Code
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If you have had training and certifications, please enter it below |
Cardiopulmonary Resuscitation
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Expiration Date
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COM
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Expiration Date
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Basic Life Support
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Expiration Date
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Emergency Response
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Expiration Date
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First Responder
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Expiration Date
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Certification Number
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Emergency Medical Technician
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Expiration Date
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Certification Number
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Introduction to Safety Training
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Expiration Date
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Certification Number
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Basic Vehicle Rescue
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Expiration Date
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Certification Number
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Emergency Vehicle Operator
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Expiration Date
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Certification Number
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Other Training
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Expiration Date
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Certification Number
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Other Training
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Expiration Date
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Certification Number
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Membership Guidelines require a criminal record check. Please visit the PA State Police website, where you can have your background check done for $10. When you receive the completed Background Check, mail or bring it to the Fire Company. If you want to drive emergency vehicles, an Emergency Vehicle Operator Course and Drivers License Check may also be required. |
Do you have any physical or mental disabilities which could limit your safe participation in fire company activities? |
Have you ever been convicted of a felony or misdemeanor?
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If you have, please explain
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Do you have any physical or mental disabilities which could limit your safe participation in fire company activities?
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If so, please explain
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Have you had a 3D Hepatitis B vaccine?
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Hepatitis Date
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Have you had a Tetanus Booster?
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Tetanus Date
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References: Use Business associates, co-workers, etc. DO NOT use family members or clergy. Due to previous experience with new members, we need to check references.
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Reference One |
First Name
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Last Name
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Address
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City
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State
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Zip Code
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Phone Number
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Relationship
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How Long
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Reference Two |
First Name
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Last Name
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Address
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City
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State
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Zip Code
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Phone Number
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Relationship
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How Long
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Reference Three |
First Name
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Last Name
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Address
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City
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State
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Zip Code
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Phone Number
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Relationship
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How Long
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Have you been recommended by a member ofthe Tafton Fire Company?
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Tafton Member
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Tafton Fire Company will not discriminate on the basis of race, color, national origin, sex, or handicap in it's activities, programs or membership.
Please Note: Applications received are read at the next fire company meeting following receipt, references are checked, and applications are voted at the following fire company meeting unless there is a problem. If a problem arises, applicant will be notified by phone or in writing. Memberships do not take effect until dues are paid for year of application.
Be Advised: You will be asked to come in for an interview.
All equipment issued to members, belongs to the Tafton Fire Company. I will take care of any property and equipment issued to me. Equipment must be returned upon request or termination to the Tafton Fire Company.
Under penalty of perjury, I certify that the above information is true. Upon being voted in as a member of the Tafton Fire Company Inc, I agree to abide by the current by-laws, rules and regulations and guidelines. (A copy of the by-laws is available upon request prior to joining.) I will obey any reasonable request issued by a superior officer.
Please type your full name, as it appears at the top of this form. This, along with the digitally recorded date, time and your IP address, will constitute your Digital Signature. If you are under 18 years of age, you must have your Parent or Guardian make an appointment to visit the Tafton Fire Company, to approve and sign your documents. |
I agree to all of the terms in this document
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Digital Signature (Your Full Name) |
Email Address |
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