PVFD Membership Application

  • Petersburg Volunteer Fire Department

    Membership Application

  • Date of Birth*
     / /
  • Format: (000) 000-0000.
  • Phone Number 1
  • Format: (000) 000-0000.
  • Phone Number 2
  • Do you have any physical conditions which limit the amount, type, or duration of strenuous physical work which you can perform?*
  • Please select Fire Department Branch you are interest in joining:*
  • Format: (000) 000-0000.
  • Have you been subject to an investigation or disciplinary action pertaining to drugs or medical practices.*
  • Have you ever been convicted of a violation of federal or state law, excluding minor traffic violations, with in the last 15 years.*

  • References:

    (At least one local reference and one professional reference)

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • I certify that my answers upon this application form are true. I authorize investigation of all statements on this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. I also agree to provide volunteer service to the community in the branches checked above for a period of not less than two years upon being accepting into membership. I also agree to follow the department's by-laws and policies. Please attach a copy of a background check to this application. You will be reimbursed after one year of acceptable service for the cost of the background check.

  • Date*
     / /
  •  
  • Should be Empty: