Organization Phone: 610-767-9339

Application

Application

Instructions:

Please complete all parts of this application form by providing as much accurate and full information as possible. 

Full information will include legal name, phone numbers, and all other necessary details.

At the end of the application you will be requested to fill out a Statement of Certification that will serve as an electronic signature.

An email address is required, but please leave at least one phone number for us to contact you about your application.

 

Address
Address
City
State/Province
Zip/Postal
Country
Emergency Primary Contact Address
Emergency Primary Contact Address
City
State/Province
Zip/Postal
Country
Emergency Secondary Contact Address
Emergency Secondary Contact Address
City
State/Province
Zip/Postal
Country
Parent or Guardian Address
Parent or Guardian Address
City
State/Province
Zip/Postal
Country
Employment Address
Employment Address
City
State/Province
Zip/Postal
Country
Reference Name
Reference Name
First
Last
Reference Address
Reference Address
City
State/Province
Zip/Postal
Country
Reference Name
Reference Name
First
Last
Reference Address
Reference Address
City
State/Province
Zip/Postal
Country
Reference Name
Reference Name
First
Last
Reference Address
Reference Address
City
State/Province
Zip/Postal
Country
Statement of Certification:
Applicant Name
Applicant Name
First
Last
Time
By selecting the drop down value of YES, I accept and wish to proceed and upon submission, I hereby claim to the best of my knowledge, all the information I have provided on this application is true and correct. Further, I understand that any information which has been given incorrectly is cause for rejection or dismissal from the company. Permission is hereby granted to Lehigh Township Volunteer Fire Company # 1 to contact any and/or all persons listed in this application, and any government agency which may have knowledge of my background. I will release a copy of my criminal history to the fire department.
Sending