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Membership Application

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.

Required   Indicates Required Field
Contact Information
Date Submitted: 01/26/2022 1842
First Name: Required
Last Name: Required
Date of Birth: Required
Social Security Number: Required
Sex: Required Male
Female
Phone #: Required
Address 1: Required
Address 2:
City, State, Zip: Required
Years at Current Address: Required
Email Address: Required
Drivers License Number + Class + Experation Date: Required
Copy of License:
Please attach a copy of your license
Add files...
Occupation- Current Employer: Required
References (3): Required
Tell us about yourself:
Has your driver's license ever been suspended?: Required
If your license HAS been suspended please explain the circumstances.:
Have you ever been convicted of a crime?: Required 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: Required Yes
No
If Yes Explain Physical Limitations:
Prior Training
Prior Firefighter Training?: Required Yes
No
Prior Training: Required 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?: Required 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...
Investigation Authorization
Approve Investigation / Background Check : Required Yes
No
Attach these two forms below: PA Criminal History Background Check: Child Abuse Clearance. Links Below.
Child Abuse Clearence: Required
Add files...
PA Criminal Background Check: Required
Add files...

 

Pa Criminal Background Check

Child Abuse Clearence

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

 

 

 





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Collegeville Fire Company
29 E. Fifth Ave
Collegeville, PA 19426

Emergency Dial 911
Non-Emergency: 610-489-4464
Station Fax: 610-489-9406
E-mail: freasb@collegevillefire.org
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