Form

Do you currently have a valid and clean drivers license and driving record? If not please explain.
What is your drivers license number and state?
Do you have a criminal background that we should be aware about? If so please explain
Do you currently possess a EMT certification or higher?
Are you interested in becoming a EMT if you currently do not posses a certification?
Why do you want to become a volunteer?
What is the last four of you social security number?
Do you know anyone in the department that can validate your work ethic? If so who?
List three references( names and phone numbers)
Are we allowed to contact your references?

Note that all applicants must undergo a background and drivers record check to insure the information that is provided is true and correct. Failure to disclose information of criminal background and driving record background my result in denial of your application. Roanoke Valley Rescue Squad has the right to contact your references to validate information provided in this application.
If you agree to this please type yes.
Signature

Powered by Jotform SignClear
Only applies to junior members. Roanoke Valley Rescue Squad provides a junior program which teaches junior members multiple different skills that can be used in day to day life. If you are a junior member applicant your parent (s) must complete the following and sign. The following states that your parent understands that you are applying for a volunteer rescue squad and gives consent for you to participate in events , training and be apart of the organization. If you the parent (s) understand and agree to your child participating in the organization please type yes.
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Signature

Powered by Jotform SignClear
Should be Empty:

Volunteer Application