Rose Fire Company No. 1, New Freedom Boro, York Co., PA ("Rose Fire Company") considers applications for employment/membership without regard to race,
color, national origin, ancestry, religion, sex, age, disability, political belief, military service, citizenship or any other protected class.
Rose Fire Company IS A DRUG-FREE WORKPLACE.
IF APPLYING FOR JUNIOR EMERGENCY RESPONDER MEMBERSHIP ARE YOU AT LEAST 16 YEARS OF AGE?
Yes
No
If you are not at least 18 years of age, a parent or legal guardian must sign this Application (in addition to the Applicant), and, if you are still in high school, you must supply a work certificate.
I certify that the information I have given on this application is true, complete and correct, and I understand that any false information or the
omission of information may be considered as sufficient reason for my discharge if I become a member or employee. I recognize that completion of
this application does not mean that I will be accepted as an employee or member and does not obligate Rose Fire Company to accept me as an employee
or member. Applications will remain active for six months, after which time re-application will be necessary. If accepted for employment/membership,
I agree to abide by all rules, regulations and policies established by Rose Fire Company and its officers and other persons in charge. I understand that,
if accepted as a member, my membership is voluntary and may be terminated in accordance with the Rose Fire Company Bylaws, policies, procedures and all
applicable laws and regulations. I understand that, if accepted as an employee, my employment will be "at will" and either I or Rose Fire Company can
terminate the employment relationship at any time for any reason or no reason and without prior notice. This application is not an agreement or a contract
for employment or membership.
If offered membership or employment and at any time thereafter, I consent to medical examinations as may be required to determine my fitness to perform the
duties of employment/membership.
I understand that I may be required to undergo drug screening tests as a condition of employment or membership. To comply with this requirement, I consent
to providing a sample of my urine or other physical samples (such as blood or hair) prior to employment/membership and again at any time so requested. Specimens
will be tested for both legal (prescription drugs) and illegal substances. A positive test for legal substances will require proof of a current prescription.
I further consent to allow any doctor, hospital or testing laboratory to conduct any medical test or examination as may be required by Rose Fire Company as a
condition of my employment/ membership, and I hereby give my consent to the release of all information which Rose Fire Company deems necessary to determine my
ability to perform employment/membership duties now or in the future.
I further understand that refusal to submit to an alcohol or drug screen test at any time will result in immediate termination of my employment/membership with
Rose Fire Company.
I hereby authorize Rose Fire Company to investigate my employment/volunteer history with former employers and volunteer organizations and to make any further
investigation deemed necessary in connection with my application for employment/membership, including a criminal history check, driving history check, child
abuse clearance check, elder abuse clearance check, FBI background check, and other such inquiries. I release Rose Fire Company and all informants from all
liability resulting from such inquiries. I waive all rights to see or review the information so furnished.
I certify that I am not now, nor have I ever been excluded from any state or federal health care program. I further understand that if it is determined that
I was so excluded, my employment/membership with Rose Fire Company may be terminated.