Membership Application

Application Requirements and Guidelines

Membership in the Sheffield Township Volunteer Firefighter’s Association, Inc. is limited to residents in said fire district or non-residents operating a business in said fire district. Upon receipt of this application for membership, the Membership Committee will review the application, perform a background check and conduct an interview with the applicant. The Membership Committee, upon completion, will present this application to the Body of the fire department with a recommendation. At that time a vote for acceptance or denial will be taken. If the application is accepted, the applicant will be placed on Probationary Status for the period of six months. During this six month probationary period, the applicant shall complete all mandatory training as set forth by this department and the State of Indiana. At completion of the probationary period and mandatory training, the Body shall vote on the acceptance or denial of Probationary Member for Active membership. No applicant shall be discriminated against due to Race, Creed, Sex or Religion.

You may download the application here.

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Personal Information

Name(Required)

First Middle Last

Last 4 of SSN

Date of Birth

MM slash DD slash YYYY

Age

Sex

Physical Address

Street Address Address Line 2 City State ZIP Code

Mailing Address

Street Address Address Line 2 City State ZIP Code

Cell Phone

Celluar Device

iOS

Android

What Cellular Service Do You Use?

How long have you been a resident?

Driver's License Number

State

Marital Status

Spouse's Name

Do you have any past experience as a First Responder?

Yes

If yes, please provide details.

PSID Number (if applicable)

Have you ever applied or been on Sheffield Township Fire Department?

Yes

If yes, please provide details.

Work History

Place of Employment

Hours of Work

Phone

Address

Street Address Address Line 2 City State ZIP Code

Length of Employment

Supervisor Name

Medical Information

Height

Weight

Hair

Eyes

Ethnicity

Blood Type

Do you wear glasses/contacts?

Glasses

Contacts

Physician's Name

Phone

Medical Allergies

Current Medications

Other Pertinent Medical Information

Emergency Notification Information

Please list next of kin and/or emergency contact persons. List two:

Please include:

Name, relationship, personal phone, work phone, address, and city/zip.

Medical Evaluation(Required)

Applicant will need to schedule a respiratory test at R.O.C.C. located in the Unity Medical Center at 1345 Unity Place. Let them know that this is for Sheffield Twp. Vol. Firefighters Inc. If you have any questions, feel free to ask an officer of the department.

General Information

Is your Driver's License currently valid?

Yes

If no, explain.

Has your Driver's License ever been suspended or revoked?

Yes

If yes, explain.

Have you received any traffic tickets in the past 2 years?

Yes

If yes, explain.

Have you ever been convicted of a crime, felony or misdemeanor (excluding traffic infractions)?

Yes

If yes, explain and include month/year, city and state of the offense.

Professional References

Please list three (3) professional references.

Include name, phone, email, and relationship.

Application Requirements and Guidelines(Required)

I declare that this application is a true and complete statement of fact and that any misrepresentation or omission may result in this application being rejected or dismissal from this Department. I further give my permission and consent to the Sheffield Township Volunteer Firefighter's Association, Inc. to contact references and use my date of birth, social security number, driver's license number and any other information contained in this application to conduct a police background check and application verification. I understand this application and all information received will be held in strict confidentiality.

I, desiring to become a member of the Sheffield Township Volunteer Firefighter's Association, Inc. and a Volunteer Firefighter under the State of Indiana Acts of 1939, Chapter 163, Section 5, as amended, have read and fully understand and make the following statements:
1. I agree to enroll on a volunteer basis in the Sheffield Township Volunteer Firefighter's Association, Inc.
2. I agree to abide by the provisions of the Constitution and By-Laws of said organization.
3. I agree or affirm to uphold the Constitution of the United States of America and Constitution of the State of Indiana.
4. I agree to undergo and complete training requirements set forth by this Department, Township and by the State of Indiana.

Background Check Authorization

Former Name(s) and Dates Used

Current Address Since Month/Year(Required)

Current Address(Required)

Street Address Address Line 2 City State ZIP Code

Previous Address Since Month/Year

Current Address

Street Address Address Line 2 City State ZIP Code

Previous Address Since Month/Year

Current Address

Street Address Address Line 2 City State ZIP Code

Social Security Number(Required)

Date of Birth(Required)

Telephone Number

Driver's License Number/State

Digital Signature(Required)

I agree.

The information contained in this application is correct to the best of my knowledge. I hereby authorize Sheffield Township Volunteer Firefighter’s Association, Inc. and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and /or volunteer purposes. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to the following areas: verification of social security number; current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records.

I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Sheffield Township Volunteer Firefighter’s Association, Inc. or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources.

I hereby release Sheffield Township Volunteer Firefighter’s Association, Inc., the Social Security Administration, and its agents, officials, representatives, or assigned agencies, including officers, employees, volunteers, or related personnel both individually and collectively, from any and all liability or damages of whatever kind, which may, at any time, result to me, my heirs, family, or associates because of compliance with this authorization and request to release.

Application Requirements and Guidelines

Personal Information

Work History

Medical Information

Emergency Notification Information

General Information

Professional References

Background Check Authorization

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