If you would like to further specify how you heard about HTVFC you may use this space to do so. This help us improve our recruiting efforts.
Please list in the section below the organization name, number of years of service, the Fire Chief's name, and phone number for any organization you have been a member of.
Please explain the organizations reasoning for issuing the disciplinary action.
Please briefly explain why you are interested in becoming a member and serving the citizens of Hampden Township.
If there is anything else that you would like us to know about yourself please enter it here
Certification & Acknowledgement
I hereby submit my application for membership with the Hampden Township Volunteer Fire Company No. 1 Inc. (HTVFC). I acknowledge that completion of this application does not imply acceptance and does not obligate the HTVFC to elect me as a member. I affirm that the information contained in this application and materials I may provide with it are true and correct to the best of my knowledge and belief. I realize that any falsification or omissions in this application may constitute grounds for rejection or termination from membership.
If accepted for membership: I understand membership is voluntary and this application is not an agreement or a contract for membership or employment; I further agree to abide by all HTVFC By-Laws, rules and regulations, respect all officers and members, and conduct myself in a professional manner at all times; and I further understand that my voluntary membership may be terminated at any time in accordance with HTVFC By-Laws, rules and regulations.
If I am accepted into membership, I understand that I may be required to undergo a medical examination, and/or a drug or alcohol screening, to determine my fitness for duty. I further understand that refusal to submit to an alcohol or drug screen test at any time may result in the immediate discharge from membership with HTVFC. To comply with this requirement, I consent to providing a sample of my urine or other physical samples (such as blood or hair) after I am offered the position and prior to the start date of my position and again at any time so requested. Specimens will be tested for both legal (prescription drugs) and illegal substances. A positive test for legal substances will require proof of a current prescription. I further consent to allow any doctor, hospital or testing laboratory to conduct any medical test or examination as may be required by HTVFC as a condition of my membership, and I hereby give my consent to the release of all information which HTVFC deems necessary to determine my ability to perform the essential duties of my position now or in the future.
As part of the application process, I understand a background investigation and reference check will be conducted by HTVFC and the Hampden Township Police Department (HTPD), or their respective agents, which will include a review of public records, my driving records and any criminal history, organizations of which I am or have been an employee or member.
Furthermore, on behalf of myself and my heirs, assignees, and personal representatives, I also release and forever discharge HTVFC and HTPD, their officers, employees, agents and contractors from any and all causes of action, liability, claim, loss, cost, or expense, and promise not to sue on any such claims against any such person or organization, arising directly or indirectly from or attributable in any legal way to this background investigation and reference check process. I also release and forever discharge any individual, agency or organization providing any information about me to HTVFC or HTPD, or their respective agent(s) from any and all causes of action, liability, claim, loss, cost or expense whatsoever related to the furnishing of such information and for the use of the information in determining my fitness for membership. I waive all rights to see or review the information so furnished. I hereby authorize HTVFC to verify my volunteer or career history with former and current volunteer or career organizations and to contact individuals to verify the information contained in this application as well as to determine my fitness for membership.
I understand that as a condition of membership and prior to being able to begin membership with HTVFC, I am required to produce a current Pennsylvania state police criminal record check, child abuse history clearance, and FBI criminal background check. (The FBI criminal background check is not required if you have lived in Pennsylvania for the past ten years, and you sign the statement below indicating that you are not disqualified from being a volunteer as set forth in the statement.) I have never been convicted of arson or any related offense. I agree to notify HTVFC within 24 hours of any instance in which I am arrested or convicted of any felony or misdemeanor. I am liable for paying a non-refundable $2.00 application fee and completing the following background checks:
, if I am required by law.
- Pennsylvania State Police Criminal Record Check
- Pennsylvania Child Abuse History Clearance
- Federal Bureau of Investigation (FBI) Criminal Background Check