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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.

To find the closest Station to your location, follow this link

Required   Indicates Required Field
Submitted on: 10/22/2021 0328
Volunteer Preference : Required
Department Interested in Joining: Required
Last Name: Required
First Name: Required
Middle Name: Required
Are you under 18 years of age? : Required Yes
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
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.:
Have you been affiliated with any other fire and rescue organizations within the past 3 years?: Required
What is your primary occupation?: 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
Please type your signature here: Required
How did you hear about us?: Required
If referred, who referred you?:

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: 540-928-2201
Station Fax: 540-473-8288
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