Hampton Valley Forge Volunteer Fire Department Application

Hampton Valley Forge Volunteer Fire Department Application
Please complete and submit the online volunteer application below, after completion the Hampton Volunteer Fire Department membership committee will review your submission and contact you via email within ten business days.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Drivers License Number
Social Security Number
Marital Status
Present Employer
Employer Address
Occupation
Immediate Supervisor
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Typical Work Shift
Does your job require frequent travel out of the area?
If you work in the area, will you be able to respond during work?
Will your work shift hinder you from attending evening training sessions?
Education
High School Attended
College / Technical School Attended
College Degree / Major
Current Medical Condition
List any medical conditions which may lead to an emergency situation (examples: high blood pressure, diabetes, allergies, etc.)
Personal Physician (type none if you do not have a private physician)
Primary Emergency Contact Person (name)
Relationship
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Have you ever been a member of a fire department, rescue squad or similar?
Name of Organization
Date of Service

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position Held
List any emergency response related training you have completed
List and current Hampton - Valley Forge Volunteer Fire Department personnel who you are related to or acquainted with
References (List three references who are familure with your education or work experience)
Ref #1

First NameLast Name
Ref #1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Ref #2

First NameLast Name
Ref #2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Ref #3

First NameLast Name
Ref #3 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Have you ever been arrested, summoned into court as a defendant or indicted, convicted, fined, imprisoned, or placed on probation, or has and case been filed against you? If yes, please explain:
List any comments and or information which you feel may be pertinent to your application process:
Application Signature
Application Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: