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PERSONAL |
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Submitted on:
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01/18/2021 1218 |
Volunteer Preference :
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Department Interested in Joining:
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Last Name:
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First Name:
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Middle Name:
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Date of Birth:
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E-mail Address :
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Street Address:
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City, State, Zip:
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Home Phone:
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Cell Phone:
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Gender:
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Have you ever held a Virginia Driver's License?:
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Drivers License #:
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Highest Education Obtained:
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CRIMINAL HISTORY |
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Have you ever been convicted of a felony? :
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Have you ever been a subject of a complaint regarding neglect of an animal, child, the elderly, or anyone in your care?:
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Do you have any traffic violations in the last 3 years?:
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If you answered yes to any of the previous questions please explain.:
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EXPERIENCE |
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Have you been affiliated with any other fire and rescue organizations within the past 3 years?:
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What is your primary occupation?:
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What is your primary motivation for volunteering?:
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Please provide any previous fire departments or rescue organizations that you have been a member of |
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Department #1:
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Department #2:
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Department #3:
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REFERENCES (Please list name, address and home & work phone numbers |
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Reference #1:
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Reference #2:
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Reference #3:
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ACKNOWLEDGEMENT |
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Please type your signature here:
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How did you hear about us?:
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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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