Marshall Township Volunteer Fire Department • Membership Application Form

Marshall Township Volunteer Fire Department
P.O. Box 216, Warrendale, PA 15086
Phone: 724-935-1230
Fax: 724-934-5996
Website: https://www.marshallvfd.org

Membership Application

Name *

First

Middle

Last

Home Address *

Address Line 1

City

State

Zip Code

Home Phone

Cell Phone *

Email *

Date of Birth *

What do you want to be your primary role? *

Brigade Member (Firefighter)
Non Brigade Member (Administrative)
Associate Member (in the Brigade)

Employment Status *

Employed
Unemployed
Retired
Student

Administrative Interests

Have you ever been convicted of a felony and/or misdemeanor? *

Certifications and Signatures

I certify that all answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application; and I also authorize a complete background investigation (criminal, driver record, child protection). In the event of membership acceptance, I understand that false or misleading information given in my application or interview(s), may result in removal from membership. I understand that I am required to abide by all published and inherent rules, by-laws, and regulation of the Marshall Township Volunteer Fire Department. I have never been convicted of an offense that constitutes the crime of “arson and related offenses” under PA C.S.S. 3301 or any similar offense under 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 statements herein, I am subject to penalties prescribed by law, including, but not limited, a fine of at least $1,000.00. *

I so certify.
I do not so certify.
I do not understand

SPECIAL NOTIFICATION: A person convicted of violating this section or any similar offense under federal or state law shall be prohibited from serving as a firefighter in this Commonwealth and shall be prohibited from being certified as a firefighter under Section 4 of the Act of November 13, 1995 (P.L. 604, NO. 61) known as the State Fire Commissioner Act. We consider applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, marital status, or any other legally protected status. Applicants requiring assistance in the application process, should contact the Marshall Township Volunteer Fire Department (MTVFD) *

I have read and understand.
I do not understand.

Signature - Sign with Pointing Device *

Membership Application - Rev I 02-23-2020

Phone