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Junior Firefighter Program Application

Hershey Volunteer Fire Company

Junior Firefighter Program Application

For Applicants 14-18 years old, and/or still in high school

Required   Indicates Required Field
Today’s Date: 10/18/2024 0225
Applicants Name: Required
Age: Required
Birth Date: Required
Drivers License Number and State (if you drive):
Home Address: Required
Home Phone:
Email Address: Required
Alternate Address (if needed):
Alternate Phone:
Current School:
Grade Level:
Are your grades usually “C’s” or better: Yes
No
Please attach a copy of your most recent report card:
Add files...
Have you ever been a member of the Hershey Fire Crew: Required No
Yes
Are you related to a member of the Hershey Fire Crew: Required No
Yes
If you are related to a member of the Hershey Fire Crew, Who:
Work Permit Number: Required
Date Issued: Required
Issued by: Required
Please attach a copy of your work permit or application. You can get an application at the high school career office: Required
Add files...
Parent, Guardian or Sponsor Name: Required
Parent, Guardian or Sponsor Phone: Required
Emergency Contact Name: Required
Emergency Contact Phone Number: Required
Emergency Contact Relation: Required
What experience do you have related to the fire service:
Are you able to attend meeting and training on a regular basis (most are Monday nights from 6-9pm): Required No
Yes
Do you have any limitations (physical, mental or otherwise) that could prevent you from performing the duties of a Junior Firefighter: Required No
Yes
If you have any limitations, please explain:
List any accommodations or adaptations you might need to perform your duties:
Are you a dependable, trustworthy person, who can follow directions without hesitation: Required No
Yes
If you are not a dependable, trustworthy person, who can follow directions without hesitation, please explain:
Are you willing and able to follow rules and regulations of the fire department, local, state or federal laws: Required No
Yes
List any illicit drugs, alcohol or prescription you take:
Work History
Current Employer:
Current Employer Address:
Current Employer Phone:
Your position/title/duties:
Supervisor Name/Title:
May we contact your employer: No
Yes
How many hours per week do you usually work when school is in session:
When school is not in session:
Note: Child Labor Laws may limit your availability to be active in the department or your paid job
List any other work history:
Have you ever been in trouble with law enforcement or school officials: Required No
yes
If you have you ever been in trouble with law enforcement or school officials, please explain:
REFERENCES
Name of Friend, Co-worker, Friend of family, etc.: Required
Reference #1 Name: Required
Reference #1 Phone Number: Required
Reference #1 Email Address: Required
Reference #1 - Best time to get a hold of them: Required
Name of Teacher, school official, religious leader, etc.: Required
Reference #2 Phone Number: Required
Reference #2 email: Required
Reference #2 Best time to get a hold of them:
Read the Junior Fire Program expectations and rules at www.hersheyfire.org
Junior Applicants Electronic Signature: Required
Date Signed: 10/18/2024 0225
Parent or guardian electronic signature permission to participate: Required
Date Parent or guardian electronic signature signed: 10/18/2024 0225

By siging my electrtonic signiture above I do hereby promise to adhere and abide by the rules and regulations set-forth by Pennsylvania Child Labor Laws, Hershey Fire Company and Junior Program Guidelines. I understand that it is the right of the Hershey Fire Company to terminate this program at any time for any reason. Upon my termination (voluntary or involuntary), I will surrender all issued equipment in a timely manner.





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Hershey Volunteer Fire Department
21 West Caracas Avennue
Hershey, PA 17033
Emergency Dial 911
Non-Emergency: (717) 533-2953
E-mail: info@hersheyfire.org
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