By signing my digital signature above, I signify that I have applied for the membership to the Connoquenessing Volunteer Fire Company (CVFC); that I have answered all questions truthfully and to the best of my knowledge; and that I fully understand that any intentional false statement may be grounds for dismissal from the department. 

I understand that the Connoquenessing Volunteer Fire Company, given the type services that it provides as well as for the protection of its membership and general public is obligated under the law to only utilize volunteer members who are responsible persons. For the CVFC to make this determination in accordance with all applicable Pennsylvania laws, I understand that I must provide to the CVFC any information on any misdemeanor or felony convictions I have had ( excluding juvenile offenses unless tried as an adult) regardless of when the conviction occurred, as well as any information as to any adverse action against my driver's license (such as suspension, revocation, or other restriction of certification or license). I understand that I must provide the CVFC with any information about new state or federal convictions or adverse action against my driver's license as they occur. I understand that this is an ongoing duty and that I must provide this information while I am a member of the CVFC. I also understand that the CVFC will conduct a thorough background check as well as a reference check which may include a review of public records, criminal history, driving history, certification records, child abuse clearance screening, elder abuse clearance screening (if available) and inquiries of my former employers and organizations of which I am or have been a member or employed, and the references which I have provided regarding my qualifications to be a member of the CVFC. As part of this inquiry, I understand that the CVFC will obtain a report of criminal history information and driver's license history from applicable law enforcement agencies, state agencies, and, in some cases, the Federal Bureau of investigation, and that applicable state laws and Company Bi-Laws and/or Policy prevent persons convicted of certain crimes from applying for membership to the CVFC. If I am granted membership, the CVFC will regularly obtain updated reports of my criminal history information, driver's license history, and child and elder abuse clearance screenings. I also understand that the CVFC is a drug-free organization, and that I may be subject to a drug and alcohol test, which may be conducted at various times throughout my membership with the CVFC.

I authorize the CVFC to conduct this background and reference check as well as a Drug and Alcohol screen as part of the membership application process (if applicable), and at any time during my membership with the CVFC.

I hereby give my permission for any of my listed references to release to the CVFC any information regarding my work and volunteer experience, including but not limited to performance of expected duties and disciplinary information, to the CVFC. I authorize the CVFC to send a copy of this authorization to my listed references or anyone else contacted by the CVFC to provide information about me.

Further, on behalf of myself and my heirs, assignees, and personal representatives, I also release and forever discharge the CVFC, its officers, members, agents, and contractors from any and all causes of action, liability, claim, loss, cost, or expense, and promise not to sue on any such claims against any such person or organization, arising directly or indirectly from or attributable in any legal way to this background check. I also release and forever discharge any individual, agency or organization providing any information about me to the CVFC from any and all causes of action, liability, claim, loss, cost, or expense whatsoever related to the furnishing of such information and for the use of that information in determining my fitness for membership, I waive all rights to see or review the information so furnished.