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Lake Ariel Volunteer Fire Company

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Member Application

Application: LAFD

Applicant Information:

Thank you for your interest in joining Lake Ariel Volunteer Fire Company.

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone:

Email

Drivers License:

SSN:

Date Of Birth:

Membership Type:

Are you a citzen of the United States?

Do you have previous fire fighting experience?

Have you ever been convicted of a felony?

If no, are you authorized to work in the United States?

If Yes, Explain

EDUCATION:

Please provide as much information as possible.

High School

High School Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Did you graduate?

Yes

No

College / University

College Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Did you gradulate?

Yes

No

REFERENCES:

First Name

Last Name

Relationship:

Company Name:

Email

Phone:

First Name

Last Name

Relationship:

Company Name:

Email

Phone:

Emergency Contact

Information:

First Name

Last Name

Relationship:

Phone:

OTHER EMERGENCY INFORMATION:

This information is kept strictly confidential:

Blood Type"

Allergies:

Medical Programs:

Medication:

Military Background

Branch

Dates You Served?

Rank At Discharge

Type of discharge?

If Other Than Honorable, explain:

I certify that my answers are true and complete to the best of my knowledge.

I acknowledge that if accepted as a member, i will be subject to the rules and regulations set forth in the Lake Ariel Fire Company by laws. Disciplinary Procedure Manual, and Standard Operating Procedure (SOP) Manual. I agree that if my membership is terminated for any reason I will return all property and equipment issued to me by the Lake Ariel Fire Company immediately. I understand that if I am applying for active Firefighter status, I will be subject to a probationary period of no less than 3 months, during which time I will be responsible to attend training sessions and other company functions, as well as evaluated by Company Officers. By signing and submitting this form, I hereby give my full consent to a criminal background check, which will be used to determine eligibility for membership before acceptance.

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[email protected]

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(570) 698-5340

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1381 Lake Ariel Hwy PO Box 31, Lake Ariel, PA,

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