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Become a Member of Hughesville Volunteer Fire & EMS

Use the form below to apply for membership to the Hughesville Volunteer Fire Department & Rescue Squad, Inc. (Department). After completing this form, a representative of the membership committee will contact you. Please monitor the email address that you provide for correspondence from the Department.

The Department has two (2) membership types:

Administrative – Open to all persons 16 years and older. Administrative members provide support to the Department by performing functions that contribute to the organization but do not require you to respond to emergencies, such as Bookkeeping, Chaplain, Data Management, Fundraising, Grant Writing, Information Technology, and Social Media.
Operational – Open to all persons 16 years and older. Operational members participate in firefighting, rescue, and emergency medical activities (responds to emergency incidents, works in hazardous environments, participates in training).

*Applicants age 18 and older will be responsible for paying for their background check, Upon submission of the application, a separate message will be sent to your email address on file with instructions for completing and paying for the background check.

Personal * Indicates Required Field

Submitted on: 12/10/2024 01:12

Membership Type: *

Name: *

Last, First, Middle Initial

Address: *

Street Address, City, State, Zip Code

How long have you lived at this address?: *

E-mail Address: *

Home Phone: *

Cell Phone: *

Sex: *

Date of Birth: *

Driver's License #: *

Driver's License State: *

Have you ever been convicted of a traffic violation, misdemeanor, or a felony: *

If Yes, indicate the date and nature of the charge, police agency, court, and disposition: *

If you were in the Armed Forces, when were you discharged? : *

Place Employment History

Place of employment:

Type of work performed:

Supervisors Name:

Supervisors Contact Information:

Medical History

Emergency Services work often requires a great deal of physical effort and stress in hazardous environments. Please list any medical restrictions that will / might affect your ability to fulfill the requirements of the service interest(s) you have chosen:

Previous Fire / EMS Experience

Have you ever filed an application to join the Department? : *

If yes, when? :

Have you ever been a member of any other fire, rescue or emergency medical department(s)? : *

If you have been a member of any other fire, rescue or emergency medical department(s) please list department name(s) and date(s) and contact information:

Have you ever been denied membership to a fire, rescue or emergency medical department? : *

If yes, please give details:

Have you ever been discharged for misconduct or unsatisfactory service or asked to resign from a fire, rescue or emergency medical services department? *

If you have been discharged, please give details:

List any firefighting and/or emergency medical certifications that are current.

Please provide copies of certifications:

Upload documents here. DOC, DOCX, PDF, XLS, XLSX, PPT, PPTX, TXT, JPG, JPEG, PNG

Education

High School Attended: *

Include Location (City/State)

Did you graduate or receive a GED: *

Date graduated, or received GED:

College, University, Graduate School, Technical / Professional School:

ILocation (City/State), Dates attended, Major, Degree, Certificate awarded

References (NOT Members of the Department)

Reference #1: *

Name, Address, Phone Number

Reference #2: *

Name, Address, Phone Number

Reference #3: *

Name, Address, Phone Number

Emergency Contact

Emergency Contact Information: *

Name, Relationship, Address, Phone Number, Additional Phone Number

Acknowledgement

How did you hear about us? : *

Select ALL that apply

County Recruitment Program

Friend

Member

Recruitment Flier

School Guidance Counselor

Social Media

State Recruitment Program

Please type your signature here: *

Please read the notice below before signing.

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY. If you do not understand any of them, or if you have any questions, please contact the Department at membership@hvfdems.org

By signing my digital signature above, I signify that I have applied for the membership to the Hughesville Volunteer Fire Department & Rescue Squad, Inc.; and that I have answered all questions truthfully and to the best of my knowledge; and that I fully understand that any intentional false statement may be considered cause for rejection of this application or grounds for dismissal from the Department. Furthermore, I hereby grant to the Hughesville Volunteer Fire Department & Rescue Squad, Inc. permission to contact my employer, references, and any other persons or agencies who may have knowledge of me, my skills and my experience as may be deemed necessary and to conduct a background investigation. I also understand that I will be required to undergo a physical examination, at the applicants' expense, as a condition of participating in any formal operational training programs. If you have any questions, please contact the Department at membership@hvfdems.org.

Become a Member of Hughesville Volunteer Fire & EMS

Personal * Indicates Required Field

Place Employment History

Medical History

Previous Fire / EMS Experience

Education

References (NOT Members of the Department)

Emergency Contact

Acknowledgement

working hours

need help?

get in touch

get in touch

working hours

need help?

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Become a Member of Hughesville Volunteer Fire & EMS

Personal * Indicates Required Field

Place Employment History

Medical History

Previous Fire / EMS Experience

Education

References (NOT Members of the Department)

Emergency Contact

Acknowledgement

working hours

need help?

get in touch

get in touch

working hours

need help?