The Jefferson Fire Company No.1 of West Norriton Township, Montgomery County, Pennsylvania is pleased that you are interested in becoming a member of our fire company. The application fee is $10.00 for your membership card, due annually.

Step 1: Complete both PA State Police Criminal Records Check as well as the PA Child Abuse Certification. Upon completion of both you can than start to fill the application out.

Step 2: After your application is filled out entirely you may submit the application, If for some reason the two required background checks are not with the application we ask that you bring them with the day of your interview.

Step 3: Once your application is submitted it will be turned over to the Membership Committee for their investigation process which consist of:

• Reviewing the application
• Contacting personal references
• Contacting Employers
• Contacting current or prior fire company affiliations

Step 5: Upon completion of the investigation process, the Membership Committee will contact you to set up an interview on the Wednesday prior to the next regular monthly company meeting to discuss their findings and the operations of the fire company.

Step 6: After the interview, the Membership Committee will recommend to the general membership the approval or denial of your application. The general membership shall have the final say through vote during the monthly company meeting.

Indicates Required Field

Membership Type:		Firefighter (18+) Junior Firefighter(14-17 years old) Fire Police
Junior Firefighter Membership Working Papers: All Junior Firefighter members are REQUIRED to have working papers		Yes No
Personal Information
Last Name:
First Name:
Middle Name:
Physical Address:
City:
State:
Zipcode:
Date of Birth: Ex: 00/00/0000
Cell Phone:
Email Address:
Do you have a valid Driver's License?:		Yes No
State and Class of Driver's License:
Driver's License Number:
Occupation and School Information
Occupation:
Place of Employment:
Are you still in School?:		Yes No
Name of School (if applicable):
Emergency Contact Information
Emergency Contact Name/ Relationship:
Emergency Contact Phone Number:
Prior Firefighting Experience
Do you have any firefighting experience?:		Yes No
if yes, please provide where you have experience:
Officer in Charge: Please provide name, rank, and phone number.
Certifications:: Please provide all the certifications that you have. Copies of certifications can be made at the interview if necessary.		Add files...
Criminal Information
Have you ever been convicted of a crime?:		Yes No
If yes, please write a brief despriction:
Background Clearances
PA State Police Criminal History Check: This MUST be completed with submission of application **Junior Firefighters are Exempt**		Add files...
Child Abuse Clearance: This MUST be completed with submission of application. **Junior Firefighters are Exempt**		Add files...
References
Please provide three(3) references, not related to you. Please provide a name, address, and phone number for all three:
I certify that all statements are true. I understand that any false statements made will be grounds for rejection or dismissal. I agree to abide by the By-Laws and rules of the Jefferson Fire Company No.1
By typing my name I am certifying that all the information is honest and correct.
Signature of Applicant:
Signature of Parent or Legal Guardian (If applicant is under 18):
Date/Time of Submission:		05/02/2025 0940
Thank you for your interest in becoming a member of the Jefferson Fire Company No.1. The Membership Committee will review your application and a representative will contact you after your application has been reviewed.