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| Membership Class |
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Brigade member guidlines:
Check the box to acknowledge the following:
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The minimum age to participate in the program is 19 years old with a minimum of 1 year of firefighting experience. Missing any of the credentials listed below could disqualify acceptance to membership.
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| Personal Information |
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| Last Name:
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| First Name:
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| Middle Name:
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| Date of Birth:
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| Street Address:
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| City:
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| State:
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| Zip Code:
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| Years at this address:
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| Phone #:
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| Email:
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| Driver's License #:
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| Housing Status: |
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Own
Rent
Live with parents
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| Sex: |
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Male
Female
Other
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| Height:
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| Weight:
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| Marital Status:
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| Spouse / Partner Name:
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| Phone Number:
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| Emergency Contact Name:
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| Emergency Contact Phone #:
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| Current Employer:
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| Employer Phone Number:
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| Firefighting Experience |
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| Previous firefighting experience: |
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YES
NO
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Certifications:
Check any certification currently held:
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Essentials with Live Burn
Basic Vehicle Rescue (NFPA 1006 or DOH)
ISC 100, ISC 200, NIMS 700
Hazmat Operations (minimum with refresher within 1 year)
Emergency Vehicle Operator (EVOC or equivalent)
Pumps 1
CPR/AED First Aid
Child Abuse Clearance (PA)
State Background Check
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Driver / Operator:
Do you have previous experience as a driver of an emergency vehicle.
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NO
Ambulance
Engine
Rescue
Ladder, Truck
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| Description of Previous Firefighting Experience if any:
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Certifications:
Upload certs here
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Shift Preference (Time):
Please indicate if you have a shift preference. If you are able to, or interested in both AM/PM shifts, select 'Both'.
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Shift Preference (Day):
Please select the days that you would be interested in staffing for. Select all that would apply.
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| Background Information |
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| Place of Birth:
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| Are you a Citizen of the USA?: |
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YES
LEGAL ALIEN (Green Card)
NO
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| Military Service:
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| Names of relatives or friends (current or past) in the Murrysville Volunteer Fire Company:
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| Reference 1 Name:
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| Reference 1 Phone #:
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| Reference 2 Name:
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| Reference 2 Phone#:
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| Reference 3 Name:
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| Reference 3 Phone #:
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| Have you been refused membership or removed from any firefighting or EMS service?: |
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Yes
No
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| Are you under indictment for any crime?: |
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Yes
No
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| Have you ever been convicted of a crime in any court? (Other than traffic court): |
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Yes
No
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| Are you a fugitive from justice?: |
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Yes
No
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| Do you have any driving citations?: |
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Yes
No
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| Do you have any physical limitations or disabilities?: |
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Yes
No
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| Do you have any medical conditions or allergies?: |
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Yes
No
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| Have you ever received workman's compensation for an on-the-job injury?: |
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Yes
No
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| Are you willing to submit for a physical evaluation within 30 days of acceptance?: |
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Yes
No
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| Anything else you would like to add?:
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| Authorization |
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| I agree that the above information is true and complete: |
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Yes
No
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Authorization 1 (Enter Name):
By entering my name here, as a digital signature, I certify that this application was completed by me and that all the entries and information are true and complete to the best of my knowledge. I hereby authorize Murrysville Volunteer Fire Company #1, it's agents, my employer(s), references and local and state police to furnish and information concerning my character, habits, health, history or employment. I hereby release all such persons from any and all liability or damages on account of having furnished this information, medical, criminal or otherwise.
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Authorization 2 (Enter Name):
By entering my name here, I hereby agree that I am requesting to join the Murrysville Volunteer Fire Company #1 on a one year probationary basis and that I may be terminated during this period as the sole discretion of the Murrysville Volunteer Fire Company #1. I hereby agree that the information supply in this application will be used for the purposes of investigation. I also fully understand that I may be denied membership if I do not live or work in the district of the Murrysville Volunteer Fire Company #1.
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Thank you for your interest in the Murrysville Volunteer Fire Company!
Someone will contact you soon to schedule an in-person interview; a copy of this application will be sent to the email entered above.
Click SUBMIT below when finished
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