ALUM BANK FIRE COMPANY APPLICATION FOR MEMBERSHIP
Name *
Social Security Number *
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Phone Number *

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Height *
Weight *
Age *
Sex *
Marital Status *
Number Of Dependents *
Type of Membership You Are Requesting *
 Associate Membership 
 Active Membership 
 Junior Membership  
Are you a resident of Fire Dept. Coverage Area? *
Length of residence *
If not, what municipality?
Occupation *
Place of Employment
Do you have any physical defects or ailments?
Name of Family Physician
Have you ever been convicted of any crimes?
If Yes, Please Describe
Are you a church member?
If Yes, name of church?
Do you have any special training? First Aid, FireFighting or Rescue?
If yes, please describe
Are you willing to attend Training sessions?
Driving Expierence: Car?
Driving Expierence: Truck
Do you have a Commercial Drivers License?
Operators
Do you have any driving violations in the last five years?
If Yes, Explain
Are you willing and able to serve as volunteer Firefighter?

NOTE

NOTE: Any person signing this application should be fully aware of the duties and danger inherent to the Fire Service. Also applicants are required to complete a PA State Child Abuse and a Criminal History background check. Both must be submitted prior to being voted on.
List two personal references and phone numbers
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First
Last
Suffix
Name
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First
Last
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