Volunteer Membership Application

I respectfully submit my name for consideration as a volunteer member of the Salisbury Fire Department.
Today's Date:*
Position Applying For:*
Station Preference:*
Name:*
First Middle Last
Contact Number:*
Email Address:*
Current Address:*
Street Address Address Line 2 City State ZIP Code
Former Address (If less than one year at current address)
Street Address Address Line 2 City State ZIP Code
Are you 18 years or older?*
- Yes
- No
Social Security Number:*
Driver's License Information:*
License Number State Class
Current Employment Information:*
Employer Name Address Line City State ZIP Code
Have you ever been a member of another emergency services organization?*
- Yes
- No
If you answered "Yes", please provide the organization name and contact number of a contact person from this organization:*
Are you legally authorized to work in the United States?*
- Yes
- No
Have you ever been arrested, convicted and/or received probation before judgement for any misdemeanor, felony, DWI, DUI, or motor vehicle violation other than parking tickets?*
- Yes
- No
If you answered "Yes", please provide the circumstances:
Please provide the contact information of three (3) personal references to whom you are not related by blood or marriage:*
Select highest high school grade completed*
- 9
- 10
- 11
- 12
Select level of college education completed*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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Consent
I agree to the privacy policy.
Comments
This field is for validation purposes and should be left unchanged.