Front Royal Volunteer Fire and Rescue Department, Incorporated
Membership Application

Application Type:   

--- Personal Information ---

Full Name:   

Social Security Number:   

Mailing Address:   

City:   

Zip Code:   

Street Address:   

City:   

Zip Code:   

Date of Birth:   

Age:   

Home Phone:   

--- Employment Information ---

Present Occupation:   

Work Phone:   

Employer:   

Mailing Address:   

City:   

Zip Code:   

Supervisor's Name & Title:   

--- Education and Experience ---

Fire Training & Certifications:   

List and Fire Department or Rescue Squad where you have or had other memberships:   

--- Additional Information ---

Have you ever been convicted of a misdemeanor or felony since you became an adult?   NoYes

If "Yes" please explain below:   

Do you have any physical conditions prventing you from doing certain types of work?   NoYes

If "Yes" please explain below:   

--- References ---

The information provided by me in this application for membership is true and complete to the best of my knowledge. I hereby authorize the Front Royal Volunteer Fire and Rescue Department, Incorporated, to contact any family member, physician, employer, or any other individual to conduct a personal background investigation. (NOTE: All applicants for Junior Membership must provide a parental or guardian signature). By submitting this application, I hereby give the Front Royal Volunteer Fire Department authorization to perform a backgound check on myself.