Membership
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Application
Application to be a volunteer or part time employee. Thank you for submitting this form. Someone from our membership committee will be in touch shortly. PLEASE READ BEFORE HITTING SUBMIT I hereby authorize the membership committee of the Pleasant Hall Fire Department to conduct a complete and thorough investigation of all information and/or records germane to my application. All information released to the membership committee shall be kept confidential. Any misleading or untruthful information may be cause for the rejection of application and termination from the Department. After my introductory period, If I am found to be an unfit member, it may lead to my termination. The Pleasant Hall Fire Department and their members can not be held liable for my termination. NOTE: There is a $10.00 nonrefundable application fee. If you are under the age of 18, a worker permit and parental permission slip must be attached to the application. A sponsor must be an acti
Your full name
Any Other Names Used:
Address
State
Zip code
Have you lived outside PA; If so where?
Phone #
Email address
List any experience or training
List 2 references with phone numbers
Why do you want to join?
Drivers License Number and State
Date of Birth
Social Security #
Occupation
Employer
Have you applied to any other department if so where.
Has you membership ever been revoked from another department if so please explain.
Have you ever been convicted of a crime. If yes please explain
Has your driving privlage been revoked if yes please explain
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