Online Membership Application – Levittown Fire Company #1

Personal Information

Name *

Street Address *

Apartment, suite, etc

City *

State *

ZIP Code *

Phone *

Cell Phone

Email Address *

Date of Birth *

Month *

Day *

Year *

Age *

Marital Status *SingleMarriedSeparatedDivorced

Religion *

0 / 20

Blood Type

0 / 20

Do you have an disabilities? *

Identification

PA Drivers License Number *

License Expiration Date *

Month *

Day *

Year *

Residency

Are you a local Resident? *YesNo

How many years? *

0 / 2

How many months? *

0 / 2

Employment

Employer Name *

Street Address *

City

State

ZIP Code

Phone *

Email Address

How long employed? *

0 / 20

What are your work hours?

Firefighting Experience

Do you have any previous firefighting experience? *YesNo

If yes, Where?

Previous Chiefs Name

Phone

Email Address

Miscellaneous

Are you sponsored or known by any of our members?

Why do you want to join the Fire Company? *

What type of Membership do you desire? *Class A - I understand I will have to attend Firefighter I training to be an Active MemberClass B - I will serve on committees and work fund raising functionsClass C - I wish to join the Fire Company Auxiliary

Certification *

I understand I will be on probation for my first six (6) months of membership. I hereby give my consent to Levittown Fire Co. No. 1 to Investigate this application and all pertinent information pertaining to my character. I also understand that I will be required to submit and obtain a PA State Police Criminal Background check (https://epatch.state.pa.us/Home.jsp), a PA Child Abuse Clearance (https://www.compass.state.pa.us/cwis/public/home) and, if necessary, obtain an FBI background and fingerprint check.

You will use the volunteer submission guidelines for each of the above links. Please submit the documents in the areas below with your application if you have them. Note: We cannot allow you to volunteer until all these documents have been received.

Required documents:

Copy of Drivers License

No file chosen

Insurance Card

No file chosen

Pa State Police Criminal Background Check

No file chosen

Visit this link: https://epatch.state.pa.us/Home.jsp and use the New Volunteer Record option

PA Child Abuse Certification

No file chosen

FBI Background Check or Signed Waiver

No file chosen

2021
Month	# of Calls
Jan	17
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Total	17
2020 Total	354
2019 Total	377