Live-in Program

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Live-in Program

History of the Program:

In 2008 Station 18, following newly finished renovations, started its live-in program for students from the local college campuses. The program continues to be a valuable asset to the company and communities we provide fire and ems coverage. The program is designed for Firefighters/EMTs to utilize the station as their full-time residence, allowing for a quick and professional fire company response while not in the class room. In exchange for free living accommodations and several other perks, the live-in members are responsible for responding to emergency calls, performing station duties, and participating in trainings.

Secure private, individual sleeping areas with bed, dresser, closet, etc.
High-Speed Wireless Cable Internet Service for electronic devices throughout the 32,000 square foot facility.
Complete and Modern Kitchen Area.
TVs in multiple spacious recreation room areas.
Large Washer and Dryer
Separate Showering and Locker Room Facilities
Attractive Study Room / Quiet Area
Physical Fitness Room
Access to Company Fire and EMS Training
LVFC Will Issue Fire and EMS Gear
Secure Off-Street Parking available for one (1) vehicle.
Close to Public Transportation

Your Full Name (Last, First, Middle):

Your Address:

City

State:

Zip Code:

Permanent Address:

Permanent City:

Permanent State:

Permanent Zip Code:

Permanent County:

Telephone (Current Home):

Telephone (Current Cell Phone):

Email Address:

Please use an email address you check regularly as notifications and status changes in regard to your application will be sent to that address.

Age

Plead History will

Birthday (MM/DD/YYYY)

Social Security Number:

Driver's License Number:

Driver's License State:

Driver's License Expiration Date:

Driver's License Upload

Drag & Drop Files, Choose Files to Upload You can upload up to 4 files.

Please upload a copy of your driver's license (front and back)

Educational Background

High School Attended (Please indicate highest grade completed):

College Attended / College Currently Enrolled:

Degree / Educational Concentration:

Health / Medical History

Health Information: Do you have any health / physical conditions that would interfere with you providing emergency service?

Please describe any health or physical conditions that would interfere with providing emergency services:

Date / Time of last Medical Physical / Exam

Date

Time

Please provide your family physician's name and phone number.

Are you taking any medications on regular basis? If so, please provide a list.

Blood Type

Please select your blood type.

Vision:

Glasses
Contacts
Both (Glasses and Contacts)
None

Affiliations / Fire & EMS Service

Are you a member of another Fire Company / Department?

Yes (Please fill out next question)
No

Name and Location of the Fire Company / Department?

Chief's Name and Phone Number:

Have you ever been subject to disciplinary action as a member of another fire and EMS company or other volunteer organization

Yes (Please fill out next question)
No

If yes to question above, please list the date and explain action.

List Any Experience (Bring any/all certifications to interview):

Emergency Contact Information

Emergency Contact (Please provide Name and Best Method of contact):

Background and Criminal History

Have you ever been arrested, convicted, pled guilty, or pled no contest to any misdemeanor or felony? (Do not include criminal history that has been expunged or occurred as a minor.

Arrested

Plead Guilty

Convicted

Please include all summaries, misdemeanors, felonies, and traffic history:

I hereby understand it is my responsibility to furnish and provide Background / Criminal History:

Please bring copies of any/all clearances and background checks with you to your interview date. Pennsylvania State Police Background Checks can be completed online and accessible: https://epatch.pa.gov/home

I authorize the Loyalsock Volunteer Fire Company to perform any additional criminal background check on my behalf and understand it is my responsibility to complete such forms to include the same information regarding my past criminal history as a requirement for the Live-In Program. In addition, I authorize Loyalsock Volunteer Fire Company to contact my list of references provided as part of my character makeup prior to and following Live-In Program application and interview review.

Personal References

I authorize the Loyalsock Volunteer Fire Company to contact my list of references provided as part of my character, morals, state of mental and physical health, training recorded, and certifications prior to and following Live-In Program application and interview review.

List 3 People (including Name, Phone, and Address) not related to you that have known you for more than 3 years:

I wish to participate in Loyalsock Volunteer Fire Company No.1 (LVFC) Live-In Program. I understand that I will be contacted for an interview and that the Live-In Program Committee will make the final decision to accept or reject my application. I further understand that, if accepted into the Live-In Program, I will abide and adhere to the LVFC Trustees Manual, Current SOP/SOGs, Company By-Laws, Constitution, and Live-In Guidelines. In addition to the duties of emergency services, I understand that I will be expected to read, understand, and adhere to the Live-In Program Guidelines, Rules, and Regulations. If I fail to meet these expectations, I may be dismissed from the Live-In Program.

I hereby acknowledge all information filled out in the above sections to be correct and fully accurate. Any failed or false information will be documented and open to disclosure during interview process. If you accept the terms and conditions, please digitally type in your full name and click submit below.

Emergency Dial : 911

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Live-in Program

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Live-in Program

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History of the Program:

Benefits:

Live-In Application

Educational Background

Health / Medical History

Affiliations / Fire & EMS Service

Emergency Contact Information

Background and Criminal History

Personal References

Loyalsock Volunteer Fire Company

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