Membership Application

Apply to be a member of the Carlisle Fire Department!
Fields marked with an asterisk (*) are required. Questions regarding the Carlisle Fire Department may be directed to Chief Jeff Snyder

Preferred Fire Company*
 
Carlisle Fire and Rescue Services (Station 45)
 Union Fire Company (Station 41)
 No Preference

Volunteer Opportunities*
 Administration (Finances/Membership/Legal)
 Junior Firefighter
 Education and Outreach (Public/School Presentations and Volunteer Training)
 Equipment and Maintenace 
 Rescue Services
 Fire Fighter
 Wildland Brush Fire Fighter
 Development (Fundraising/Special Events)
 Fire Police
 Other

Personal Information

Name*:

Date of Birth


Address*:

City or Town*:

State or Province*:

Zip or Postal Code*:

Phone*:

Email*:


Work Experience
Present Position

Present Employer

Past Position

Past Employer

Employer Allows Time Off for Volunteer Service?
 Yes
 No
 Occasionally
Availability
 
Daytime
 Evenings
 Overnight
 Weekends
 Flexible

Volunteer Experience
Position

Organization

Date/Years

Position

Organization

Date/Years

Position

Organization

Date/Years


Have you volunteered with a fire company or emergency services organization in the past? If so:
Position

Organization

Date/Years

Position

Organization

Date/Years


Why did you leave?


References

Name

Phone

Email

Name

Phone

Email

Name

Phone

Email


Do you know any current members of the fire company? If so, please list their full name:
Name

Phone

Email

Name

Phone

Email

Name

Phone

Email

Name

Phone

Email


Criminal Background
Have you ever been CONVICTED of a crime? (If so, you will be asked to provide additional information.)*

 Yes
 No
Are you or anyone in your household a registered sex offender?*
 Yes
 No
Will you complete the requirements of a comprehensive background check?*
 Yes
 No

Signature Section
I understand that by submitting this application I authorize the fire company to complete comprehensive background and reference checks. I authorize that all results of the background screening process be presented to the personnel committee of the Fire Company when my volunteer application is evaluated for membership. I further certify that all information provided is accurate and correct. I understand that ANY misrepresentations will be sufficient cause for immediate dismissal from consideration of membership or removal as a member. I also certify that I am 18 years of age or older; if not, I have included a parent/guardian signature below.

Signature*

Date

Parent/Guardian Signature (if applicant is under 18)

Date


     

 

Carlisle Borough Committed to Excellence in Community Service
Borough Hall 53 West South Street + 717 249 4422 Mon-Fri: 7:30am - 4:30pm