Membership Application Form

Membership Application

First and Last Name *

Address *

Address

City

State/Province

Zip/Postal

Phone *

Home Cell

Date of Birth *

Age

Driver License

Social Security

Occupation

Work Phone

Employed By

Employer’s Address

City

State/Province

Zip/Postal

Country

Reason(s) for wanting to join the department

Firefighting and rescue

Apparatus Driver

Fire Police

Administrative Interest (Non-firefighting duties)

Junior Member (Ages 16-17 or 18 if still in high school)

Special Skills (list any skills or training which could be helpful. Administrative, mechanical, electronic, firefighting, etc.)

Are you, or have you ever, been a member of another Fire Department? Yes No If yes, please give name(s) and telephone #(s)

Do you have any medical restrictions or disabilities which would require us to make a reasonable accommodation for you to perform the duties requested?

Yes

If yes, please explain

Do you have any arrests or violations? (Including all driving violations)

Yes

If yes, please list

List 3 references; include address and telephone #, (No relatives please)

Signature of Proposed Member

Date

Signature of Sponsoring Member

Date

Printed Name of Sponsor

(Note: Sponsoring Member must be considered active)

Parent or Legal Guardian Consent Statement

(To be filled out for those under 18 years of age. Also, please attach a copy of your working papers)

Signature of Applicant's relative

Clear

Signature of Applicant

Clear

Date

Signature of parent or guardian

Clear

I hereby request the Pennsylvania Department of Transportation to furnish Fairview Township (York County) a copy of my driver record and give the Fairview Township Fire Department Vigilance Committee permission to perform a background check.

Signature

Clear

Date

Application Checklist

The following items need to be returned in order for your membership application to be processed. Missing items or incomplete applications will result in your application / membership acceptance being delayed.

Completed application

Signed

Application Sponsor /Signature

PA State Police Clearance

PA Childline Abuse Clearance

Copy of your driver’s license (Ages 18 and over)

Work Permit (Junior Members)

Apply for PSP clearance. This can be done by accessing the website at
https://epatch.state.pa.us/Home.jsp. Click on new records check. (Volunteer Only)

Access https://www.compass.state.pa.us/cwis/public/home . If you have an account, you can go straight to individual login. If you do not have an account, click on create individual account.
When you create an account, it will take you to another site. Enter the information requested. You will then get an email with your log in information. This may take up to 2 days to be delivered. Once this information is received log in to https://www.compass.state.pa.us/cwis/public/home.

If you are human, leave this field blank.

Fairview Township Fire Department provides regular mutual aid assistance to surrounding municipalities such as Lower Allen Township and New Cumberland Boro in Cumberland County, Harrisburg City and Swatara Township in Dauphin County, and Newberry Township and Warrington Township in York County.

Fairview Township Fire Department, Stations 68-1, 68-2 and 68-3. Providing fire protection to the residential area.

Membership Application Form

Parent or Legal Guardian Consent Statement

Application Checklist

Member Links

Contact Info

Emergency: 911