Last Name: _____________________ First Name : _____________________ M.I. _____
Home Phone : ________________ Cell : ________________ Work : _________________
DOB : ________________ Drivers License Number & Class : __________________
Training you received from previous fire or EMS organizations :
Please list current and past companies you are/were a member of.
Please answer the following truthfully, Your answers are not reason for any applicant being denied membership. We just
need to know which portion of the fire company you are interested in being a part of. We need help with both but fully realize
not everyone can nor want to be active members responding on emergency calls.
Are you willing to participate in firefighter training? Yes / No
Are you willing to participate in fundraising events? Yes / No
All applicants are subject to a background check, do we have your consent to perform this check. If yes please initial
& date : ____________
Upon approval of your application you will be expected to abide to the By-Laws of the Reade Volunteer Fire Company and
to respect the authority of Elected & Appointed Officers & also Senior members. We sincerely appreciate your interest
in joining our organization and shall continue to strive to maintain a Fire Company that is “ready, willing and able”
to serve the residents and visitors of Reade Township.
Signature : _____________________________________________ Date :________________