Step 1 of 2 50% The Montgomery County Volunteer Fire & Rescue Association and all of the Local Fire & Rescue Departments value diversity in the workplace. Men and Woman of all ages, cultural and ethnic backgrounds, religious and political affiliation, national origin, and person with disabilities are encouraged to apply. To apply, please complete and submit this official application form. The application shall be completed in full. We may wish to contact you by mail, telephone, and/or email. It is your responsibility to make sure contact information is correct and current. Except to accommodate the needs of individuals with disabilities, committee members cannot complete or change any information on the application. Any changes must be made by the applicant in person or through signed written communication Please note that your information is saved as you enter it. You have the option to save your application and return later.I acknowledge that I understand the requirements of becoming and being a volunteer in Montgomery County, and am ready to proceed to the application.* Yes No I'm Interested In Becoming a Volunteer ...* Firefighter/EMS EMS Only Live-In HS Cadet/Junior Member Administrative Auxiliary Other Department Applying To*Select ....Bethesda-Chevy Chase Rescue SquadBethesda Fire DepartmentBurtonsville Volunteer Fire DepartmentDamascus Volunteer Fire DepartmentCabin John Park Volunteer Fire DepartmentGaithersburg Washington Grove VFDGermantown Volunteer Fire DepartmentGlen Echo Fire DepartmentHillandale Volunteer Fire DepartmentHyattstown Volunteer Fire DepartmentKensington Volunteer Fire DepartmentLaytonsville District Volunteer Fire DepartmentRockville Volunteer Fire DepartmentSandy Spring Volunteer Fire DepartmentSilver Spring Volunteer Fire DepartmentTakoma Park Volunteer Fire DepartmentUpper Montgomery County VFDWheaton Volunteer Rescue SquadDon't Know/No Specific DepartmentReferred By (If Applicable) About YouName* First Middle Last Email* Enter Email Confirm Email Home Address Street Address Apt Number/Suite City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone*Work PhoneMobile PhoneHave you ever been convicted/sentenced/placed on probation for a criminal offense or traffic offense in an adult court?*Minor traffic offenses may be omitted Yes No Are you a U.S. Citizen?* Yes No Are you at least 18 years of age?* Yes No Date of Birth* Month Day Year If yes, give details including date, charge, location, and disposition of the case(s)*Employment / Student Status*Select ...Full Time EmployedPart Time EmployedHigh School StudentCollege StudentCombination of Employment/SchoolRetiredOccupation*Please tell us your occupation if employed Do you have a current Driver's License or State-issued ID?* Yes, Driver's License Yes, State Issued ID Only Neither Driver's License/ID No.* State Issued*Select ...MarylandVirginiaDistrict of ColumbiaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificOther Outside U.S.License Zip Code*Has your driver's license ever been suspended or revoked?* Yes No If yes, explain giving dates, etc.Prior Fire/Rescue/EMS ExperiencePrior fire, rescue, EMS or public safety experience is NOT REQUIRED, however if you do have prior experience please indicate it below accordingly.Have you ever applied to or been a member of this department or any Montgomery County Volunteer department before?* Yes No If yes, date applied/membership dates?* List Prior Department(s) in Montgomery County* Reason(s) for leaving:* Have you ever served in another fire department, rescue squad or other emergency service organization outside of Montgomery County?* Yes No Name of Other Department/Organization(s)* Location of Other Department/Organization(s)* Reason(s) for leaving:*Indicate why you left this department OR indicate if you are currently a member -- and whether you will be leaving upon acceptance into a Montgomery County department Do you have any prior/current fire, rescue or EMS training, training or courses?* Yes No Fire, Rescue or EMS Training*Detail emergency services training, education, certifications and/or courses/class hours. (Examples: Essentials of firefighting, 125 hours, EMT-B, CPR, Firefighter I). Prior training is NOT required. EducationEducation Level*Please list your highest level of completed educationSelect ...In High SchoolHigh School GraduateGEDIn College NowSome CollegeCollege Associates DegreeCollege Bachelor's DegreeHigher EducationOtherName & Location of Last High School Attended* Did You Graduate?* Yes No, Still Enrolled No, Did Not Complete, Not Enrolled Name & Location of College or University Attending/Attended*Add N/A or describe other if not applicable Degree(s) Awarded*Add N/A or describe none if not applicable Other relevant training that should be included in your emergency services file?Please list any special skills, interest or hobbies which may be relevant to your application: Please list any foreign languages spoken and/or read: Work HistoryCurrent Employer* Current Employer Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current Employer Phone*Employed From* MM slash DD slash YYYY Employed ToSelect today's date if still employed here MM slash DD slash YYYY Military ExperiencePlease detail any military experience. We will ask you for a copy of your DD-214.Have you served or are you currently serving in the US military?* Yes No Please list the branch(es) of service:* Years of Service*Ex: 1990-Present, 2012-2017 Type of discharge (if no longer active) Narrative & More InformationPlease check all that apply to your interests and desires when deciding on where to volunteer* Truck Company Work Engine Company Work Rescue Squad Work Medic Unit / Paramedic Ambulance / EMT Close to a College In My Neighborhood Near Work Near a Metro Stop/Station Other/No Specific Requests How did you hear of this volunteer opportunity?* Radio Ad TV Ad School Event County Fair Search Engine Department Website Other Website MSFA Convention Ocean City Newspaper Ad Personal Referral Why do you want to become a volunteer first responder? (100-500 words):*ReferencesPlease list two personal and two professional references. Family members may not be used.Reference #1 Name* Reference #1 Email* Reference #1 Phone*Reference #1 Type*SelectPersonalProfessionalReference #1 City/State* Reference #2 Name* Reference #2 Email* Reference #2 Phone*Reference #2 Type*SelectPersonalProfessionalReference #2 City/State* Reference #3 Name* Reference #3 Email* Reference #3 Phone*Reference #3 Type*SelectPersonalProfessionalReference #3 City/State* Reference #4 Name* Reference #4 Email* Reference #4 Phone*Reference #4 Type*SelectPersonalProfessionalReference #4 City/State* Certifications & AuthorizationsI hereby certify that the statements contained herein are true and correct to the best of my knowledge. I understand that should the investigation disclose material misrepresentation, omissions, and/or falsifications, my application may be rejected, or if a member, my membership and all rights and privileges of my membership may be terminated. My signature on this application indicates I have read the job description for the position which I am applying for and I understand that the job of a firefighter/rescuer and/or EMT is physically challenging and that my membership is dependent upon successful completion of a physical examination to be conducted by Montgomery County Occupational Medical Services and a favorable background investigation to be conducted by Montgomery County Fire/Rescue Office of Internal Affairs. This is to certify that I am the applicant and that I do hereby authorize the release of any and all information to the Local Volunteer Fire/Rescue Department(s) (LFRD) where my application is sent, that they may request, from any of my records or files. Such information may include, but will not be limited to: military records, volunteer records, employment records, education records, criminal records, and transcripts, etc. I also release all persons from any and all liability, which could result from furnishing said information to the LFRD, or an agent of an LFRD. Further, I authorize the LFRD to copy or otherwise reproduce this original document and let such copied or otherwise reproduced copy act as the original document. The original document is to be retained on file with the LFRD and this authorization to release information shall expire from one (1) year of the date signed by me. Further, I authorize the investigation of all statements contained herein, and direct the custodian of any of the records relevant to the confirmation of these to release such information necessary for verification. I further understand that the information obtained by the Local Fire Department during the application process will not be revealed to me should my application be rejected. I have read, or have had read to me the statements above and my signature below agrees to these statements above. I AGREE*Enter your FULL NAME. By entering your full name and submitting this form I acknowledge all of the above statements and that the information submitted in this form is truthful and accurate. CommentsThis field is for validation purposes and should be left unchanged. Δ
