Volunteer Membership Application Type of membership requested:(Required) Cadet (Under 18) Firefighter EMT/Paramedic Fire and EMS Auxilliary/Support Unsure Applicant Name(Required) First Last Parent/Guardian Name (if applicant is under 18 years of age) First Last Applicant Address(Required) Street Address Address Line 2 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 Applicant Phone(Required)Applicant Email(Required) Are you a licensed driver?(Required) Yes No License State(Required) 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 Driver's License Number(Required) Are you legally authorized to accept work and remain in the United States?(Required) Yes No Do you speak English fluently?(Required) Yes No What is your highest level of education?(Required) Graduate School Undergraduate Diploma Undergraduate Student High School Diploma/GED High School Student School Name(Required) Military experience? Former Active Active Reserve None Have you previously been a member with Salisbury or another Fire/EMS agency? Yes No Agency name(s)(Required) List any skills, talents, or abilities that you feel could benefit the Salisbury Fire DepartmentHow did you hear about our Department?(Required) Facebook Instagram Current Member City Website Other Other:(Required) Acknowledgement(Required) I agreeI hereby certify that all the information presented in this application is true to the best of my knowledge. I understand and acknowledge that if I have knowingly provided false or misleading information on this application, I will be subject to immediate dismissal. I authorize the Officers of the Salisbury Fire Department, Inc. and the membership committee of said organization to conduct a full investigation of my background and the information listed, and further understand and acknowledge that if I am a cadet applicant, upon obtaining the age of 18, I will be transferred to Probationary Membership. I further acknowledge that a prerequisite to Probationary Membership is a criminal background investigation. Any applicant with a criminal record of a felony will be refused membership in the Salisbury Fire Department, Inc. I will not hold any members of the Salisbury Fire Department, Inc. responsible for any information revealed, discussed, or presented during this investigation. Reasonable accommodations will be made; however, certain physical abilities are required for those involved in the delivery of fire and emergency medical services.
