We Are an Equal Opportunity Employer s1

McAdoo Fire Company Inc. We are an equal opportunity employer

Mailing Address: PO BOX 116 McAdoo PA 18237

Physical Address: 34 South Kennedy Drive McAdoo PA 18237

Phone: 570-929-2042 TTY/TDD 1-800-564-5984

Confidential Membership Application All applications shall be of sound mind body and of good moral character. Applicants should be fully aware of the duties he / she shall be expected to perform and the hardships and dangers these duties may present. As a member of this organization you will be expected to participate and maintain training standards/ certifications, work sessions and fund raising efforts as well as your normal duties. Illegal use of drugs is expressly forbidden and shall be cause for immediate dismissal. Guns are forbidden on all company property. By-laws are provided at time of acceptance. You must be able to comply with the bylaws and policies of this fire company. Standard Operating procedures will be available for review and shall be a guidance tool for your roles in the fire company. Applicant’s for membership as Junior Firefighters should include one current school teacher for a reference.

Notice It is the policy of the McAdoo Fire Company Inc. to require ALL new membership applicants to submit a Criminal background check with their application for membership in this organization. The applicant shall be responsible for all cost of this background check. ($10.00) No criminal background checks shall be older than six months. No applications will be accepted without required documents. This policy also applies to ALL former members reapplying for membership

Membership Classification:

Active Firefighter ($9.00) (14 to high school graduation) Junior Firefighter ($5.00)

All applicants must attach the proper amount for application fee

Junior Firefighters must have working papers completed and attached to application. Juniors must have their parents or legal guardians sign the application.

Active Firefighters must have the following: Criminal Background record ($10.00) Application fee of $9.00 Child Abuse Clearance

FOR OFFICE USE ONLY

Application Fee: YES NO .

Date of Submission: .

President’s Signature: .

Secretary Signature: .

Accepted Denied .

Probation Start Date: End Date: .

Full Name:

Date of Birth: Social Security #

Current Address: City: State: Zip Code:

Home Phone #

Cell Number:

E-Mail Address:

Driver License #: Class: State:

Current Employer:

Address:

Years Employed: Phone:

Superviosor(s):

Can we contact your present employer? Yes No

Do you now or have you ever belonged to any other fire or EMS Organization?

YES NO

List Organization(s)

Reason for leaving other organization(s)

Do you have any physical injuries, disabilities or problems that would in any way affect your performance in this fire company

Is there anything listed in your criminal/ Traffic record?

Please name three (3) references not related to you for us to contact:

1. Name Phone:

2. Name Phone: 3. Name Phone:

A member from this Fire Company must propose you to be a member

Proposed by: Print Sign

All Fire and or Emergency Medical Service certificates must be attached

I, the undersigned, affirm that all the above statement is true to the best of my knowledge. I also agree to abide by all company rules and regulations as put forth by the bylaws, policies and standard operating procedures/ guidelines of this company. Failure to do so will result in my suspension or dismissal from this company. I understand that I must submit this application with all required documentation and it must be completed truthfully.

Signature of Applicant:

If any of this information is false this calls for dismissal for this company.

Emergency Contact Information:

Name: Phone:

Name: Phone: Junior Applicants ONLY

Signature of parent(s) / Legal guardian:

Please circle the following that apply to you

Ethnicity

Hispanic or Latino

Not Hispanic or Latino

American

Indian / Alaskan

Native American

African American

Native Hawaiian Gender

Other Pacific Islander Male

White Female

McAdoo Fire Company Inc. We are an equal opportunity employer

Mailing Address: PO BOX 116 Physical Address: McAdoo PA 18237 34 South Kennedy Drive McAdoo PA 18237

Station Phone: 570-929-2042 Social Club: 570-929-1222 TTY/TDD 1-800-564-5984

Social Membership ($6.00)

Name: Date of Birth:

Current Address:

City: State: Zip Code: .

Home Phone # Cell Phone #

Driver License # Class: State:

Signature: .

Proposed by: Print Name: .

FOR OFFICE USE ONLY

Application Fee: YES NO Date of Submission:

President’s Signature:

Secretary Signature:

Accepted Denied .

Please circle the following that apply to you

Ethnicity

Hispanic or Latino

Not Hispanic or Latino Race

American

Indian / Alaskan

Native American

African American

Native Hawaiian

Other Pacific Islander

Gender

Female