Exit this survey GIS-10 Volunteer Tracking Form Question Title 1. Department: Warrenton (Co.01) Remington (Co. 2) Marshall (Co. 03) The Plains (Co. 04) Upperville (Co. 05) Catlett (Co. 07) Goldvein (Co. 08) New Baltimore (Co. 10) Orlean (Co. 11 Lois (Co. 13) Undecided/Unsure Question Title 2. Today's Date: Date Date Question Title 3. What is your LAST name? Question Title 4. What is you FIRST name? Question Title 5. Contact Information: Address (No PO Boxes): * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Email Address: * Phone Number: * Question Title 6. How did you learn about us? How Did You Learn About Us: Please select all that apply Newspaper advertisement Radio advertisement Television advertisement Banner at the station Story in the local media Email Brochure Career day at school Facebook Friend or family memeber referral Tragic experience Firefighter referral Firefighter station or truck tour Fundraising event Special event Please select all that apply How Did You Learn About Us: menu Other (please specify) Question Title 7. What is your primary occupation? Question Title 8. What percentage of the people you know are in the fire service? Please select one: What percentage of the people you know are in the fire service? 0%-5% 6%-10% 11%-25% 25%-50% More than 50% What percentage of the people you know are in the fire service? Please select one: menu Question Title 9. What are your motivations for volunteering to be a firefighter? Select all that apply. Fire response Service to my community HAZMAT Receiving/Delivering training Appreciation from people Friendship/Camaraderie EMS response Personal fulfillment/Enrichment Retirement benefits Incentives Tax savings for the community Financial Equipment (trucks, tools, etc.) Family connection Keeps me in shape It may be the only thing I am good at Administrative duties Adrenaline rush Personal obligation Heightened community status Other (please specify) Question Title 10. Select the motovation that is most important to you. Fire response Service to my community HAZMAT Receiving/Delivering training Appreciation from people Friendship/Camaraderie EMS response Personal fulfillment/Enrichment Retirement benefits Incentives Tax savings for the community Financial Equipment (trucks, tools, etc.) Family connection Keeps me in shape It may be the only thing I am good at Administrative duties Adrenaline rush Personal obligation Heightened community status Other (please specify) Question Title 11. Do you use social media? Do you use Facebook? Do you use Twitter? If asked, would you use Twitter of Facebook to help enlist firefighters? Do you think using Twitter to recruit firefighters is a good idea? Do you think using Facebook to recruit firefighters is a good idea? Done
