VOLUNTEER APPLICATIONTo 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 nottake volunteers; please choose the closest Guilford County station.
Choose a department
Fire District 13
Fire District 28
Guil-Rand Fire District
Mt. Hope FD
Oak Ridge FD
Pleasant Garden FD
PERSONAL AND CONTACT INFORMATION
How long have you lived at your current address? Years Months
List other addresses from the past 5 years:
How long have you worked at your current job? Years Months
References: (Other than relatives) One must be an employer.
Call Day or Night?
Have you ever been in the Fire or Rescue Service previously?If yes, please answer the questions below.
Reason for Leaving:
Certifications (Check all that apply):
EMT CPR First Responder Rescue Other Medical:
FF1 FF2 Driver/Operator TR Other Firefighter:
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
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:
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)
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