Membership Application Procedure

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1.Obtain, complete, and return membership application form to the membership committee.

2.The membership committee, after having reviewed the application, will read the application at a regular meeting and also offer the committee's recommendation.

3.The quorum present will decide if the applicant should be accepted as a probationary member.

4.Upon acceptance as a probationary member the membership committee shall notify the applicant.

5.The membership committee shall then provide the probationary member with a general orientation.

6.Basic training (In House) will be provided by the Line Officers and other approved firefighters. Upon completion of this basic training, the recruit will be allowed to man apparatus and respond to emergencies.

7.The recruit will remain in probationary status until approved by the chief.

8.When the recruit is removed from probation, a motion may be accepted by the chairman at a regular meeting to accept the recruit as a regular member based on the by-laws.

9.Annual dues will be accepted at this time, which are $4.00 Per Year, and a $9.00 One Time Application Fee.

   

SCOTT TWP. HOSE CO. NO 1

MEMBERSHIP APPLICATION

 

  • 1.Name: ________________________________________

    2.Address: _____________________________________

    3. Phone: ( )__________ 4. SS # ________________

    5.Date of Birth _________________ MM/DD/YYYY

    6.Do you have any impairments, physical, mental, or medical, which would interfere with your ability to take an active part in fire department operations?

    If yes, Please explain. _________________________

    ________________________________________________

    7.Are you currently receiving (or have you at any time received) any type of disability or workmen's compensation payments?

    YES / NO

    8.Do you have or are you being treated for any communicable diseases?

    YES / NO

    9.Do you possess a High School diploma or G.E.D. Certificate?

    YES / NO

    If yes, from where? _________________________________________

    10.If you have any formal post High School education please list institution, area of study, and degree earned.

  • _________________________________________________
        
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    Scott Twp. Hose Co.

    Membership Application

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  • Applicant Name: _______________________________

    11.Current Place of employment:

    Name: ___________________________________________

    Address: ___________________________________________

    Phone: ( ) _________________

    Position / Job Class: _______________________________

    Supervisor: ________________________________________

    12.Have you ever been convicted of a crime other than a traffic violation?

    YES / NO   If yes, when, where, and nature of offense:

    ________________________________________________

    ________________________________________________

    Are there any charges (other than traffic) pending against you?

    YES / NO

    13.Do you have any fire fighting, rescue, or EMS experience?

    YES / NO

    13a. If yes, List organization(s) where obtained.

    Name: ____________________________________________

    City: ________________State: _____________________

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    Phone: ( )______________ Yrs of Service_______

    Position held: _______________________________

       
  • Scott Twp. Hose Co.

    Membership Application

    Applicant Name: _______________________________

    13b. Do you have any fire fighting, rescue, or EMS training documented by a certificate of completion / attainment?

    YES / NO  If yes, please list. (Use back if req.)

    ________________________________________________

    ________________________________________________

    ________________________________________________

    14.Do you possess a current valid PA Driver's License?

    YES / NO  If Yes, ______-_______-_________

    15.Briefly state why you are interested in becoming a member of the Scott Twp. Hose Co.

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    ________________________________________________

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  • 16.Indicate the area(s), which are of interest to you.
  • ( ) Fire Fighting ( ) Fund Raising

    ( ) Rescue ( ) Maintenance ( )Dive

    ( ) Fire Police ( ) Vehicle Operation

    ( ) Emer. Medical ( ) Jr. Fire Fighter

    ( ) Other: ___________________________  

     
    • Scott Twp. Hose Co.

    Membership Application

      

    Applicant Name: _______________________________

    17.Personal Reference (unrelated):

    ____________________________________________________

    18.I certify that the information recorded on this application is correct. I agree to abide by the rules, policies, and regulations of the Scott Twp. Hose Company if I am admitted as a member. If any application information is found to be false, and/or I am deemed not to be in compliance with the rules, policies, and regulations, I agree to voluntarily withdraw from membership. I hereby authorize the release of any and all information concerning this application.

     

    _______________________________        Date:______/_____/______

    Signature Date 

    Membership in the Scott Twp. Hose Co. #1 is not restricted to anyone by reason of race, sex, religion, national origin, nor any other ethnic consideration.

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