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Join The Community Fire Company!

We are looking for volunteers!

Join and be a part of the fire company

Submit Your Application!

Application For Membership

Personal & Contact Information

First Name *

Middle Name

Last Name *

Type of Membership *

Date of Birth *

Address *

Address

Street Address 1

Street Address 2

City

State/Province

Zip/Postal

Home Phone

Cell Phone

Driver Information

Drivers License #

State Issued

Expiration

Have you ever been convicted of any offense other than a minor traffic violation? *

Yes

If yes, please explain

Emergency Contact Information

Name of Emergency Contact *

Relationship *

Phone

Address of Emergency Contact *

Address of Emergency Contact

Street Address 1

Street Address 2

City

State/Province

Zip/Postal

Employment Information

Current Employer

Current Employer Address

Street Address 1

Street Address 2

City

State/Province

Zip/Postal

Supervisor

Supervisor Phone #

Previous Membership & Experience

Do you have any physical impairment that may interfere with your performance with CVFC? *

Yes

If yes please explain

Have you ever applied for membership with CVFC? *

Yes

If yes give aprox. Date

Attach Certificates

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List any certifications (Fire & EMS) Attach a copy of each to application

List Three (3) persons not related to you for references

Reference Name *

Phone *

Address

Street Address 1

Street Address 2

City

State/Province

Zip/Postal

Reference Name *

Phone *

Address

Street Address 1

Street Address 2

City

State/Province

Zip/Postal

Reference Name *

Phone *

Address

Street Address 1

Street Address 2

City

State/Province

Zip/Postal

PLEASE READ AND SIGN

I herby authorize Community Volunteer Fire Company Inc. of District 12, and its membership committee to investigate the statements made of this application. I will abide by the rules, regulations & by-laws set forth by Community Volunteer Fire Company Inc. of District 12. I have enclosed Five ($5.00) dollars to cover my membership dues and have filled out the attached LOSAP application.

Print Name *

Applicant Signature *

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Parent/Guardian Signature

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Date *

Date

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Community Volunteer Fire Company Inc. of District No. 12

16 hours ago

For those who came to our Saturday night bingo this past weekend, we are looking for holder 013 on the King Tutt jar. We have some money for you! ... See MoreSee Less