Volunteer Application

First Name: Middle Name: Last Name: Email: Phone Number: Birthdate: Address: Position: Why do you want to volunteer? Have you ever been arrested?

Please explain:

Have you ever been convicted or received a plea or Noelle Prosecution for a crime?

Please explain:

Have you ever had any traffic violations or received PBJ in the last 5 years?

Please explain:

Have you ever been a member of any other Fire, EMS or Rescue Company (Career or Volunteer)?

Please explain (name and years):

Do you have any certificates?

Is it MFRI FF1 or Maryland EMT? Select year earned if so.

MFRI FF1

Maryland EMT

Other

Digital Signature: