Membership Application

The Friendship Fire Company Diving-Rescue Unit constantly seeks individuals who share our commitment to serving the community. If you wish to become a part of our team, kindly complete the application form provided, and one of our officers will contact you promptly.

Due to the specialized nature of our operations, Friendship Fire Co. does not accept junior members without a Parent or Guardian already being a active member of the organization. Prospective members must be 18 years of age or older to submit an application.

By completing and submitting the form below you are authorizing the Friendship Fire Company or its Designee to conduct a criminal background check utilizing the submitted information. Membership is contingient upon passing a criminal background check as well as a majority vote of the current membership. Submission of an application does not guarentee membership.

Indicates Required Field

Name

Date of Birth

Cell Phone Number

Home Phone Number

Work Phone Number

Email Address

Address

City

State

Select your current state of residence

Select Below Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

How many years have you been resident of Pennsylvania?

Driver License Number

Driver's License Issuing State

Select Below Alabama - AL Alaska - AK American Samoa - AS Arizona - AZ Arkansas - AR California - CA Colorado - CO Connecticut - CT Delaware - DE District of Columbia - DC Federated States of Micronesia - FM Florida - FL Georgia - GA Guam - GU Hawaii - HI Idaho - ID Illinois - IL Indiana - IN Iowa - IA Kansas - KS Kentucky - KY Louisiana - LA Maine - ME Marshall Islands - MH Maryland - MD Massachusetts - MA Michigan - MI Minnesota - MN Mississippi - MS Missouri - MO Montana - MT Nebraska - NE Nevada - NV New Hampshire - NH New Jersey - NJ New Mexico - NM New York - NY North Carolina - NC North Dakota - ND Northern Mariana Islands - MP Ohio - OH Oklahoma - OK Oregon - OR Palau - PW Pennsylvania - PA Puerto Rico - PR Rhode Island - RI South Carolina - SC South Dakota - SD Tennessee - TN Texas - TX Utah - UT Vermont - VT Virgin Islands - VI Virginia - VA Washington - WA West Virginia - WV Wisconsin - WI Wyoming - WY

Driver License Expiration Date

Highest Educational Level Attained

Select Below High School Graduate Associate's Degree Bachelor's Degree Master's Degree Doctorate

Emergency Contact

Relationship of Emergency Contact

Emergency Contact Phone Number

Have you ever been charged with an/or convicted of a felony or misdemeanor

No Yes

If replying yes to the question above, please provide the location and explain the event

Are you now serving or have ever served in any branch of the military

No Yes

Branch of Service

Air Force Army Coast Guard Marine Corps Navy Space Force

Highest attained rank

Dates of service

Is there any reason that your current state of health would in any way restrict your participation as an emergency service provider

No Yes

If answering yes to the above, please explain

Do you suffer from any medical condition, fears or phobias that might negatively impact upon your performance as an emergency service provider

No Yes

If you suffer from any medical condition, fears or phobias that might negatively impact upon your performance as an emergency service provider, please explain

Do you have any fire, rescue, dive-rescue or EMS experience or certifications

No Yes

If answering yes to the above, please list relevant experience or certifications

Have you previously been, or currently are a member of any other fire company, rescue squad or EMS organization

No Yes

If answering yes to the above, please list those organizations

Do you have any skills, abilities, hobbies, training or education other than that listed for any of the questions above that would in any way benefit our organization

No yes

If you have any skills, abilities, hobbies, training or education other than that listed for any of the questions above that would in any way benefit our organization, please explain

Briefly state what makes you desire to become a member of our team

Submit