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Become a Gallitzin Fire Company Member!!

Contact us today!

Please use the form below to apply for membership to the Gallitzin Fire Company. After completing this form, a representative of the membership committee will review your application, complete a background check on you, and then during the following Regular membership meeting, your application will be voted on. You will then be contacted with the determination. Meetings are held the first Tuesday of every month at 19:00 hours (7:00 PM).

In the meantime, feel free to browse our website or visit our station to see what the Gallitzin Fire Company is all about.

Thank you for your interest!

Required   Indicates Required Field
Todays Date/Time: Required 07/22/2024 1107
APPLYING FOR (PLEASE CHECK ONLY ONE) Note: If you applying for Special Duties/Social Member, please skip Sections 3, 4, 5 (Emergency Service Information)
Membership Type: Required Junior Firefighter
Firefighter
Fire Police
EMR
QRS Response Only
Social Member/Special Duties
SECTION 1 - APPLICANT INFORMATION
First Name: Required
MI:
Last Name: Required
Date of Birth: Required
SSN (For Background Check): Required
Primary Phone: Required
Cell Phone Number (if different):
Current Address:
House number, Street, State, Zip Code
Required
Mailing Address (if different from current address):
House number, Street, State, Zip Code
Email Address: Required
Height:
Weight:
Blood Type:
WILL YOU TAKE A PHYSICAL AT YOUR OWN EXPENSE?: Required YES
NO
SECTION 2 - DRIVER AND BACKGROUND INFORMATION
Driver's License Number:
State Issued:
Class:
MOVING VIOLATIONS OR CITATIONS IN LAST 3 (THREE) YEARS: Required YES
NO
If so, please describe violations/citations:
MOVING VIOLATIONS OR CITATIONS IN LAST 3 (THREE) YEARS
HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR?: Required YES
NO
If so, please describe charge(s):
HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR?
SECTION 3 - FIRE TRAINING INFORMATION
Please list all training:
You may also attach any certifications
Please attach training certifications if you prefer:
Add files...
SECTION 4 - EMERGENCY MEDICAL TRAINING (IF APPLICABLE)
Medical Training: N/A
First Aid
EMT
Paramedic
HP
Other
Medical Certification #:
Medical Certification Expiration Date:
SECTION 5 - EMERGENCY SERVICE AFFILIATIONS
CURRENT member of a fire department?: Required YES
NO
If so, please list other CURRENT departments, Contact OFFICER NAME, & PHONE NUMBER:
PREVIOUS member of a fire department?: Required Yes
No
If so, please list other PREVIOUS departments, Contact OFFICER NAME, & PHONE NUMBER:
SECTION 6 - EMERGENCY CONTACT INFORMATION
Emergency Contact Name: Required
Emergency Contact Address: Required
Emergency Contact Phone Number: Required
Emergency Contact Relationship: Required
How did you hear about becoming a volunteer?: Friend
Family
Advertisement
Facebook
Website
Other:
Questions/Comments:
SECTION 7 - SIGNATURES
MINOR INFORMATION - PLEASE NOTE!!:
IF YOU ARE UNDER THE AGE OF 18, YOU WILL NEED WORKING PAPERS (WORK PERMIT) FROM YOUR SCHOOL. YOU ,USTALSO OBTAIN A SIGNATURE FROM A PARENT AND/OR LEGAL GUARDIAN GIVING YOU PERMISSION TO JOIN THE ORGANIZATION.
Required AGREE
DISAGREE
N/A
SIGNATURE AGREEMENT:
I hereby am applying for membership to with the Gallitzin Fire Company No. 1. My membership will become effective upon decision by the Board of Trustees. I also understand that it may be required of me to submit a background check at my expense from the Pennsylvania State Police. When accepted to the organization, I understand that I will remain a Probationary Member of Gallitzin Fire Company No. 1 until at which time I meet any and all standards set forth by the fire company. Furthermore, I understand that I can withdrawal from this company at anytime I so desire and that it must be in writing. I also state that I am of good moral character and I will abide by all polices and procedures set forth by the By-Laws and Standard Operating Procedures for which section of the company I am applying for. I also state that all signatures are my own and not forged, and that all statements are true and forth coming. I understand that any false information of this application will deny me from becoming a member of Gallitzin Fire Company No. 1.
Required AGREE
DISAGREE
Parent or Guardian Signature:
Parent or Guardian Signature Date Signed:
Parent or Guardian Relationship to Minor:
Applicant Signature: Required
Applicant Signature Date Signed: Required




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Gallitzin Fire Company, No. 1
210 Saint Thomas Street
Gallitzin, PA 16641
Emergency Dial 911
Non-Emergency: (814) 886-8010
E-mail: info@gallitzinfire71.com
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