EmailMe Form - Volunteer Membership Application

Date Application Submitted

MM / DD / YYYY

Name

First Last

Address *

City *

Zip *

Email *

Cell Phone *

Have you ever been convicted of a felony

Yes

No

Current Employer, if retired enter RETIRED *

Your position

Supervisors name

Supervisors telephone number

Do you currently have a smart phone ?

Have you ever been involved in either a paid or volunteer fire department or rescue squad?

PAID FIREFIGHTER

VOLUNTEER FIREFIGHTER

RESCUE SQUAD MEMEBR

BOTH PAID AND VOLUNTEER FIREFIGHTER

If a member of a Fire or Rescue Squad please tell us briefly about your experience in this capacity.

Have you ever belonged to a volunteer organization? *

YES

NO

If you have had experience with a volunteer agency please describe your duties. If you are no longer with them please give a description of why you are no longer with them. *

Please tell us a little about yourself and why you feel you would be an asset to the Metro Richmond Flying Squad. *

How did you hear about the Metro Richmond Flying Squad? *

Personal Reference # 1 *

First Last

Personal Reference Phone # 1

### - ### - ####

Personal Reference # 2 *

First Last

Personal Reference # 2 Phone

### - ### - ####

Emergency Contact

First Last

Phone

### - ### - ####

Emergency Contact Address

City, State, Zip Code

DISCLOSURE FOR CONSUMER REPORTS

In connection with my application for employment (including contract or volunteer services) with Metro Richmond Flying Squad Inc., I understand consumer reports will be requested by you (“Company”). These reports may include, as allowed by law, the following types of information, as applicable: names and dates of previous employers, reason for termination of employment, work experience, reasons for termination of tenancy, former landlords, education, accidents, etc. I further understand that such reports may contain public record information such as, but not limited to: my driving record, workers’ compensation claims, criminal records, etc., from federal, state, and other agencies that maintain such records.

In addition, investigative consumer reports (gathered from personal interviews, as applicable, with former employers or landlords, past or current neighbors and associates of mine, etc.) to gather information regarding my work or tenant performance, character, general reputation and personal characteristics, and mode of living (lifestyle) may be obtained.

If I am offered a volunteer position, I understand that my employer can use this disclosure and authorization to continue to obtain such consumer reports throughout my employment, contract period or volunteer service.

Please type your name in the field below as an electronic signature