Become a Warrington Fire Company No. 1 Volunteer

These items may be submitted in person when applicant meets with the Fire Company Board

Indicates Required Field

PERSONAL

Submitted on

10/28/2026 2016

Membership Type Required

Name

Address

Cell Phone Required

Home Phone

E-mail Address Required

Social Security # Required

Sex

Date of Birth Required

Driver's License # Required

Driver's License State Required

Has your license ever been suspended? Required

If yes, please explain

Where are you currently employed? Required

Please provide the address and phone number of your current employer Required

Have you ever been convicted of a traffic violation, misdemeanor, or a felony Required

If Yes, indicate the date and nature of the charge, police agency, court, and disposition

Did you serve in the Military?

If yes, what branch and when were you discharged?

MEDICAL HISTORY

Have you ever had an operation? Required

Have you ever been seriously injured? Required

Have you ever been refused employment for reasons of health? Required

Have you ever been forced to resign from a job or volunteer position for health reasons? Required

Have you ever fractured any bones or dislocated any joints? Required

Have you ever been refused life insurance? Required

Have you ever been diagnosed with an illness caused by your job or volunteer position? Required

Have you ever injured your back? Required

Have you ever suffered from lung problems? Required

Have you ever suffered from heart problems? Required

Have you ever suffered from swelling of the legs or ankles? Required

Have you ever suffered from fainting spells or dizziness? Required

Have you ever suffered from frequent headaches? Required

Have you ever been treated, hospitalized or on medication for mental illness? Required

Do/are you currently wearing glasses? Required

Do/are you using a hearing aid? Required

Do/are you on any medications? Required

Do you have any disabilities that may affect your ability to perform firefighting duties? Required

If you answered yes to any of the above, please provide more information.

EXPERIENCE

Have you ever filed an application with Warrington Fire Company ? Required

If so, when?

Do you have any prior experience in Fire Services / Emergency Medical Services? Required

If yes, where, what, when, and for how long?

Have you ever been denied membership to a fire and/or rescue squad? Required

If so, please give details

Have you ever been discharged for misconduct or unsatisfactory service or asked to resign from a fire and/or rescue department? Required

If you have been discharged, please give details

List any firefighting and/or emergency medical certifications that are current. Please provide copies of certifications

Please provide copies of certifications

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EDUCATION

High School Attended Required

Graduation Status Required

Date graduated, received GED, or Anticipated Graduation Required

College or University Attended

Degree Earned

Date Graduated or Anticipated Graduation

REFERENCES (NOT Members of Warrington Fire Company )

Reference #1 Required

Please provide name, address, and phone number

Reference #2 Required

Please provide name, address, and phone number

Reference #3 Required

Please provide name, address, and phone number

EMERGENCY CONTACT INFORMATION

Emergency Contact Name Required

Relationship Required

Address

Phone Number Required

ACKNOWLEDGEMENT

SUBMISSION

Signature

Please read the statement below, review your application, and then sign here

Date of Signature Required

10/28/2026 2016

By signing above, I do hereby authorize any investigative officer of Warrington Township Fire Company No. 1, or the Warrington Township Police Department to have released to him/her any and all information they deem necessary concerning my background. These may include, but are not limited to: school transcripts, medical records, disability or workers compensation status (relating to ability to perform the duties) adult and juvenile arrests and/or contacts with police departments and driving records in reference to my becoming a member with the Warrington Township Fire Company No. 1. The above application has been read and the statements are true and correct to the best of my knowledge. I understand that any misrepresentation or false statements or omissions of facts may be cause for immediate dismissal.

***ADDITIONAL FORMS / ITEMS NEEDED TO COMPLETE APPLICATION***

ADDITIONAL FORMS / ITEMS NEEDED TO COMPLETE APPLICATION