VOLUNTEER APPLICATION
To volunteer with a fire department, please complete the application below.  All fields are required.

Please choose the fire department with which would you like to volunteer.
NOTE: If you are not sure which station is closest to you, check the map of
Guilford County Fire Departments.  Greensboro and High Point do not
take volunteers; please choose the closest Guilford County station.

Choose a department Alamance FD Climax FD Colfax FD Fire District 13 Fire District 28 Gibsonville FD Guil-Rand Fire District Horneytown FD Julian FD Kimesville FD McLeansville FD Mt. Hope FD Northeast FD Oak Ridge FD Pinecroft-Sedgefield FD Pleasant Garden FD Southeast FD Stokesdale FD Summerfield FD Whitsett FD

PERSONAL AND CONTACT INFORMATION

Full Name:

Birth Date:

Phone Number:

E-mail Address:

ADDRESSES

Physical Address:

City:

State:

Zip:

Mailing Address:

City:

State:

Zip:

How long have you lived at your current address?      Years           Months

List other addresses from the past 5 years:

1.  Address:

City:

State:

Zip:

2.  Address:

City:

State:

Zip:

3.  Address:

City:

State:

Zip:

EMPLOYMENT

Employer:

Occupation:

Address:

City:

State:

Zip:

Shift Worked:

          How long have you worked at your current job?  Years    Months

REFERENCES

References:  (Other than relatives)  One must be an employer.

1.   Name:

Phone:

Call Day or Night?

Address:

City:

State:

Zip:

2.   Name:

Phone:

Call Day or Night?

Address:

City:

State:

Zip:

3.   Name:

Phone:

Call Day or Night?

Address:

City:

State:

Zip:

EXPERIENCE

Have you ever been in the Fire or Rescue Service previously?
If yes, please answer the questions below.

   Yes        No

1.  Department:

Phone:

Call Day or Night?

Address:

City:

State:

Zip:

From: (mm/yy)

To: (mm/yy)

Position Held:

Reason for Leaving:

2.  Department:

Phone:

Call Day or Night?

Address:

City:

State:

Zip:

From: (mm/yy)

To: (mm/yy)

Position Held:

Reason for Leaving:

Certifications (Check all that apply):

 EMT       CPR        First Responder       Rescue       Other Medical: 

 FF1        FF2         Driver/Operator       TR              Other Firefighter: 

COURT RECORD

Have you ever been convicted for any offense other than traffic violations?       Yes       No

If yes, list charge, when, where and disposition of case:

Do you have a valid North Carolina driver’s license?       Yes       No      Class: 

Have you been convicted of any traffic violations in the past 3 years:     Yes        No

If yes, list charge, when, where and disposition of case:

ACKNOWLEDGMENT AND AUTHORIZATION

I understand that willful falsification of information or the withholding of information requested on this application will result in my application not being accepted by the fire district. Typing my full name and the date of this application below will server as my “electronic signature” verifying my understanding of the terms of this application and the accuracy of the information provided.

Full Name:       Date: 

INVESTIGATION AUTHORIZATION

TO WHOM IT MAY CONCERN:

I, , DO HEREBY AUTHORIZE ANY MILITARY ORGANIZATION, DOCTORS, INSURANCE COMPANIES, EDUCATION INSTITUTIONS, GOVERNMENTAL AGENCIES, AND INDIVIDUALS TO FURNISH THE CHIEF OF A FIRE DEPARTMENT IN GUILFORD COUNTY, WITH ANY OR ALL AVAILABLE INFORMATION REGARDING MY BACKGROUND IN ORDER THAT THE CHIEF OR HIS AGENT MAY DETERMINE MY SUITABILITY FOR PUBLIC SERVICE.

I AUTHORIZE MY CURRENT AND/OR FORMER EMPLOYERS TO GIVE ANY INFORMATION REGARDING MY EMPLOYMENT, TOGETHER WITH ANY INFORMATION THEY MAY HAVE WHETHER OR NOT IT IS ON RECORD.  I HEREBY RELEASE THEM FROM ANY DAMAGE WHATSOEVER FOR ISSUING SAME.

I ALSO PERMIT THE CHIEF OR HIS AGENT OF A FIRE DEPARTMENT IN GUILFORD COUNTY TO CONDUCT A POLICE AND COURT RECORDS INVESTIGATION OF MY BACKGROUND.

I HEREBY CERTIFY THAT THERE ARE NO WILLFUL MISREPRESENTATIONS IN OR FALSIFICATION OF THE ABOVE STATEMENTS AND/OR ANSWERS TO QUESTIONS.  I AM AWARE THAT SHOULD THE INVESTIGATION DISCLOSE ANY SUCH MISREPRESENTATIONS OR FALSIFICATION, MY APPLICATION WILL BE REJECTED.

I UNDERSTAND THAT, IF ACCEPTED, I WILL BE ON PROBATION FOR A PERIOD OF ONE YEAR AND DURING THAT TIME I AM SUBJECT TO BEING DISCHARGED FOR ANY REASON.

BY MY USING THE E-SIGNATURE FEATURE OF THIS ONLINE APPLICATION, I REPRESENT AND WARRANT THAT I HAVE THE LEGAL RIGHT AND AUTHORITY TO AGREE TO ALL TERMS CONTAINED IN THE ELECTRONIC RECORDS OF THIS ONLINE APPLICATION.  I FURTHER AGREE THAT MY USE OF THE E-SIGNATURE FEATURE OF THIS ONLINE APPLICATION CONSTITUTES AND “ELECTRONIC SIGNATURE” AS DEFINED BY THE ELECTRONICS SIGNATURES IN GLOBAL AND NATIONAL COMMERCE ACT AND THE UNIFORM ELECTRONIC TRANSACTIONS ACT, AND THAT I HAVE ENTERED INTO AND ACCEPTED THE TERMS SPECIFIED HEREIN FOR THE USE OF THE E-SIGNATURE FEATURE OF THIS ONLINE APPLICATION.
 

Type your full name to e-sign the application:          Date: 

SUBMIT THE APPLICATION

Submission security code: (type as shown)