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Membership Application

Connoquenessing Volunteer Fire Company 180 Main Street
PO Box 242
Connoquenessing, PA 16027
Emergency: 9-1-1 
Business (724) 789-9335
Fax (724) 789-722
Proudly serving the Connoquenessing Borough, Township and surrounding comunities since 1935

 

Required   Indicates Required Field
Name:
Last, First, Middle Initial
Required
Type of Membership: Firefighter
EMT | EMR
Jr. Firefighter (Under 18 years)
Fire Police
Social Membership (Non-Emergency Service)
Street Address (full): Required
Telephone Number: Required
Email Address: Required
Municipality: Required
Date of Birth: Required
Have you ever belonged to any other fire company: Required
If you have belonged to any other fire company, please list:
Have you ever been arrested: Required
If you have ever been arrested, please provide details:
Do you have any medical condition(s) which you are being treated for: Required
Are you on any maintenance medication(s): Required
Do you have any physical disabilities that may impair you for functioning at an emergency: Required
Are you on disability: Required
SB583 was passed and signed into law as Act 168 of 2006. This law forbids anyone convicted of Arson from serving as a firefighter in Pennsylvania or being certified under the certification program.
Have you ever been convicted of ANY Arson related crime(s): Required
Acknowledgement
Digital Signature : Required
Date & Time Submitted: 03/15/2026 2018

By signing my digital signature above, I confirm that I have applied for membership with the Connoquenessing Volunteer Fire Company (CVFC). I affirm that all information provided in this application is truthful and accurate to the best of my knowledge, and I understand that any intentional false statements may result in dismissal from the department.

I understand that, due to the nature of the services the CVFC provides and for the protection of its members and the public, the CVFC is obligated under Pennsylvania law to accept only responsible individuals as members. To allow the CVFC to make this determination, I agree to disclose any misdemeanor or felony convictions (excluding juvenile offenses unless tried as an adult), regardless of when they occurred, as well as any adverse actions taken against my driver’s license (e.g., suspension, revocation, or restrictions). I further agree to report any new convictions or license actions that occur during my membership.

I understand that the CVFC will conduct a thorough background and reference check, which may include review of criminal history, driving records, certification records, child and elder abuse clearances (where available), and inquiries with former employers, organizations, and references I have provided. This process may involve obtaining reports from law enforcement agencies, state agencies, and the Federal Bureau of Investigation. I acknowledge that CVFC bylaws and applicable laws may restrict membership for individuals convicted of certain crimes. If I am granted membership, I understand that the CVFC may regularly update these background checks and clearances.

I also understand that the CVFC is a drug-free organization and that I may be subject to drug and alcohol testing at any point during the application process or my membership.

I understand that the CVFC will conduct these background checks, reference checks, and drug/alcohol screenings as part of the application process and at any time during my membership. I grant permission for my references to release information regarding my work or volunteer experience, including performance and disciplinary records, to the CVFC. I authorize the CVFC to provide copies of this authorization to my listed references or other entities contacted during the screening process.

Furthermore, on behalf of myself and my heirs, assigns, and personal representatives, I release and hold harmless the CVFC, its officers, members, agents, and contractors from any liability, claims, losses, or expenses arising directly or indirectly from this background check. I also release any individuals, agencies, or organizations providing information to the CVFC from any liability related to the furnishing and use of such information in determining my fitness for membership. I waive any rights to review or access this information.

I understand that my application is subject to approval or rejection by the CVFC. If accepted, my probationary membership will begin the day my application is read at the next business meeting. The probationary period will last six months, during which I am expected to demonstrate my ability to learn and perform as an active member.

Emergency service personnel are encouraged to attend weekly training sessions every Tuesday at 7:00 PM. All members are strongly encouraged to attend the monthly business meeting on the second Tuesday of each month at 7:30 PM.

For questions, please contact recruitment@cvfc12.com.





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Connoquenessing Volunteer Fire Company
180 Main Street
PO Box 242
Connoquenessing, PA 16027
Emergency Dial 911
Non-Emergency: (724) 789-9335
E-mail: info@cvfc12.com
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