Use the form below to apply for membership to the Collegeville Fire Company. After completing this form, a representative of the membership committee will contact you. In the meantime, feel free to come by and visit the station. Remember, no experience required! This form is also not a comitment to membership, our membership team will reach out to you and answer any questions you might have. We look forward to your application and would enjoy the opportunity to welcome you as a member of our team.

Once you complete entire form, hit the submit button at the bottom of the page!

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Date Submitted:		04/25/2024 0328
Contact Information
First Name:
Last Name:
Date of Birth:
Social Security Number:
Sex:		Male Female
Phone #:
Email Address:
Current Address
Street Address: eg. 29 E 5th Avenue
City: Eg. Collegeville, Trappe, Royersford, Perkiomen
State: Eg. PA, MD, DE,NJ
Zip Code:
Years at Current Address:
Previous Address Information
Previous Address :
Years at Previous Address:
Driver License Information
Driver's License Number:
Class of Driver's License: Please check all that Apply		A-CDL B-CDL C M
Copy of License: Please attach a copy of your license		Add files...
Has your driver's license ever been suspended?:		Select Below Yes No
If your license HAS been suspended please explain the circumstances.:
Employment Information
Employment Status:		Employed Un-Employed Retired Self-Employed Disability
Occupation & Employer Information: Include Address; phone numbers and years employed
Previous Employers:
References (3): Please list Names & Phone Numbers and Email addresses
Tell us about you
Community Activities: Lions Club, Scouts etc.
Have you ever been convicted of a crime?:		Yes No
If you HAVE been convicted of a crime please describe the circumstances.:
Do you Physical Limitations that would prevent you from performing Firefighting duties:		Yes No
If Yes Explain Physical Limitations:
Prior Training
Prior Firefighter Training?:		Yes No
Prior Training-Type:		None Firefighter I Firefighter II Hazardous Materials Operations Vehicle Rescue Technician Water Rescue Awareness Water Rescue Operations Current First Aid, CPR & AED Infectious Control, Bloodborne Pathogens Pump Operations Emergency Vehicle Operators Course NIMS 100 NIMS 700
Upload Certifications:		Add files...
Current or Past Membership(s): Are you a current or past member of another Fire / Ambulance / Rescue Department. (If yes explain & include references.)
Any other training or experience?:
Membership Type
What type of membership are you applying for?:		Active 18+ years Junior Firefighter - 16/17 years Fire Police + 18 years Contributing
Junior Firefighters: Please attach working papers with this application. All Jr firefighter applicants and parents must meet with the Fire Chief		Add files...
Emergency Contact Information.
Name(s): List Name or Names
Address(s): List in same order as names
Cell Phone #'s: List in same order as Names
Home Phone #: List in same order as Names if available. If none, use XXX-XXX-XXXX
Email Address(s) Of Emergency Contact: List in same order as Name(s) If none available, use XXXXXXXXXXX
Investigation Authorization
Child Abuse Clearence:		Add files...
Approve Investigation/Background Check: By clicking yes to the approve Investigation/background check, you authorize the appointed members of the Collegeville Fire Company No. 1, to invistigate all information contained within this application. This investigation will include a criminal history check, drivers license record check with any appropriate authority. And that you understand that this application my be reviewed any time, and that falsification of information my be grounds for disciplinary action, including and up to termination from the Collegville Fire Company No. 1		Select Below Yes No
Attach these two forms below: PA Criminal History Background Check: Child Abuse Clearance. Links Below.
PA Criminal Background Check:		Add files...
Pa Criminal Background Check Child Abuse Clearence History Clearence Check By clicking yes to the approve Investigation/background check, you authorize the appointed members of the Collegeville Fire Company No. 1, to invistigate all information contained within this application.  This investigation will include a criminal history check, drivers license record check with any appropriate authority.  And that you understand that this application my be reviewed any time, and that falsification of information my be grounds for disciplinary action, including and up to termination from the Collegville Fire Company No. 1