Wilkins Township V.F.C. #304


Serving our community since 1953
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Wilkins Township Volunteer Fire Department Station #304

APPLICATION FOR MEMBERSHIP

Application for:   Active   Associate   Junior        Date:

Name:

Address

Telephone   

Date of Birth (MM/DD/YY)     Ht.    Wt.

Drivers Lic. #     Class    Eye Color

Hair Color    Blood Type    Allergies

Previous Firefighting Experience:

 
I have never been convicted of an offense that constitutes the crime of 
"arson and related offenses" under 18 Pennsylvania C.S. 3301 or 
any similar offense under any Federal or state law. I hereby 
certify that the statements contained herein are true and correct to the
best of my knowledge and belief. I understand that if I knowingly 
make any false statement herein, I am subject to penalties prescribed 
by law, including, but not limited to, a fine of at least $1,000.
 
Do you agree in whole with the above statement. 
Initials    Date 
 

A background check will be performed on all applicants through NCIC (Criminal) and PennDOT (Driver)

 

 

 
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