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Membership Application

Join Our Team!

Use the form below to apply for membership with Botetourt County Fire & EMS. After completing this form, a representative will contact you.

Submission of this form represents permission for the Botetourt County Fire & EMS to conduct a background check using the information supplied

Required   Indicates Required Field
PERSONAL
Submitted on: 10/31/2020 2133
Volunteer Preference : Required
Department Interested in Joining: Required
Last Name: Required
First Name: Required
Middle Name: Required
Date of Birth: Required
E-mail Address :
Street Address: Required
City, State, Zip: Required
Home Phone:
Cell Phone:
Gender: Required
Have you ever held a Virginia Driver's License?: Required
Drivers License #:
Highest Education Obtained: Required
CRIMINAL HISTORY
Have you ever been convicted of a felony? : Required
Have you ever been a subject of a complaint regarding neglect of an animal, child, the elderly, or anyone in your care?: Required
Do you have any traffic violations in the last 3 years?: Required
If you answered yes to any of the previous questions please explain.:
EXPERIENCE
Have you been affiliated with any other fire and rescue organizations within the past 3 years?: Required
What is your primary occupation?: Required
What is your primary motivation for volunteering?: Required
Please provide any previous fire departments or rescue organizations that you have been a member of
Department #1:
Department #2:
Department #3:
REFERENCES (Please list name, address and home & work phone numbers
Reference #1: Required
Reference #2: Required
Reference #3: Required
ACKNOWLEDGEMENT
Please type your signature here: Required
How did you hear about us?: Required

BA criminal background check and DMV report is required for all volunteers. You will be contacted in person to give your social security number. By pressing the submit button below, I certify that I have completed this application to the best of my knowledge and ability.

I certify that the above information is true, complete and accurate. Falsification of information is grounds for dismissal. I also understand that I am giving permission to Botetourt County to run a criminal background check and DMV report.





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Botetourt County Fire and EMS
205 North Roanoke Street Suite 1
Fincastle, VA 24090
Emergency Dial 911
Non-Emergency: 301-725-3345
Station Fax: 540-473-8288
E-mail: emergencyservices@botetourt.org
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