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More Links
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Employee Area
First Name
Middle Name
Last Name
Date of Birth
Social Security Number
Email
Address
City & State
Zip Code
Home Phone
Work Phone
Cell Phone
Email
High School Graduate (Yes/No)
YES
NO
Graduation Date (Or Anticipated)
Name of High School
GED?
ENTER BELOW ANY COLLEGES, UNIVERSITIES OR TECHNICAL SCHOOLS ATTENDED
Pennsylvania Drivers License #
Other Permits Held
Current # of Points (If any)
Class of License
Driving Restrictions (If any)
Has your license ever been revoked?
YES
NO
Have you ever been convicted of a felony? (YES/NO)
YES
NO
If yes, please give exact details (conviction, offenses, location of offense, sentencing court, date of sentence and nature of sentence.)
Have you previously served in a volunteer emergency service? (circle one)
YES
NO
If yes, where and when?
Do you have any military experience?
YES
NO
BRANCH
ARMY
NAVY
MARINE CORPS
AIRFORCE
COAST GUARD
Years of Service
Type of Discharge
Honorable
Dishonorable
Entry-Level Separation
Medical Discharge
Other Than Honorable Discharge
Bad Conduct Discharge
Dismissal
Date of Discharge
Please list any school honors, organization memberships unique skills etc...
Please list any members of THRS that you know
Please list any additional information you consider pertinent to your application for membership
Reference #1 Name
Reference #1 Phone
Reference #2 Name
Reference #2 Phone
Reference #1 Address
Reference #1 City & State
Reference #1 Zip Code
Reference #2 Address
Reference #2 City & State
Reference #2 Zip Code
Please attach your typed Cover Letter (PDF or Word Doc)
Please attach your Resume (PDF or Word Doc)
My Signature Below Indicates that I have Read, Understand and Consent to the above Statements. The Authorization or Photocopy shall serve as a consent for the Tri Hampton Rescue Squad to request any information concerning my application.
Signature Date
Submit Volunteer Application
X