Candidate Application

Please fill out the application in its entirety. Once complete, a member of our recruitment staff will contact you in regards to next steps. We thank you for your interest.

Privacy & Certification Notice:
By filling out the form herein, you authorize the Spotsylvania Volunteer Fire Department, & its subsidiaries or related governmental entities to obtain, investigate, or further acquire information in regards to pursuing membership into the department. Furthermore, while all efforts are made to ensure confidentiality of all records submitted, you hereby acknowledge and release the department and its subsidiaries as custodian of such records from any and all liability of damages due to this voluntary release of information.

You understand that the use of illegal drugs is strictly prohibited and grounds for immediate termination. The use of alcohol or misuse of prescription drugs prior to or during duty is a serious violation punishable up to and including termination. I understand that I may be subject to random drug testing at any time. Your signature, represented by completing the form and clicking "submit" authorizes drug screening, investigative reports, criminal history and driving record checks, reference checks, and physical examination if required.

By submitting this document, you hereby certify that all of the information submitted is your own, is truthful to the best of your knowledge and ability, and is subject to the above referenced data regulations and release. It is then understood that any false information or omission may disqualify you from the process and may additionally result in immediate discharge if discovered at a later date.


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* 1. Date & Time Of Application

Date
Time

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* 2. Applicant Information

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* 4. Do you have any physical health condition that would prevent you from performing the duties of the job role you selected?

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* 5. If you answered “yes” for question #4 above, please specify with details, otherwise type N/A if you chose “no”

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* 6. Do you have any allergies to medicine, vaccine, or other allergy that we should be aware of?

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* 7. If you answered “yes” for question #6 above, please specify with details, otherwise type N/A if you chose “no”

Background Information

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* 8. Social Security Number

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* 9. Do you have a legal right to work in the United States (Proof Required)

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* 10. Have you ever been convicted of a crime?

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* 11. Have you ever been convicted of Driving While Intoxicated or Under the Influence?

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* 12. Have you ever been denied or terminated membership from a public safety agency?

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* 13. Have you ever been dismissed or forced to resign from any position?

Education (Most Recent First)

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* 14. College, University or Trade School

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* 15. High School

Certifications

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* 16. Please List any relevant certifications & their expiration that you possess. If there are none, please type "N/A"

Employment History

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* 17. Employment #1 (Most Recent First)

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* 18. Employment #2 (If none, Type N/A For each Field)

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* 19. Employment #3 (If none, Type N/A For each Field)

Volunteer Experience

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* 20. Experience #1 (If none, Type N/A For each Field)

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* 21. Experience #2 (If none, Type N/A For each Field)

Character & Professional References

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* 22. Reference #1

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* 23. Reference #2

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* 24. Reference #3

Emergency Contact(s)

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* 25. Primary Emergency Contact

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* 26. Secondary Emergency Contact *If not applicable please put N/A In each field*

Line of Duty Service Questions

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* 27. If lost in the line of duty (LOD), Who would you want to notify your emergency contact? *Example: Chief, Officer or friend in the department - state the name

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* 28. Do you wish for a Department Chaplain to be present at time of notification?

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* 29. Do you wish to have a full Fire Service funeral?

Virginia DMV Records Request

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* 30. Template Link Below
*Directions: Please click the link below, to download the form, it is form fillable
A. Click the link Below and then click download in the top left corner (see example below)
B. Open the PDF in Adobe Reader & Fill out the fillable and Highlighted sections in the document or by hand writing in blue ink, to be scanned for the next step
C. Type "Completed" in the answer box below

VA DMV Download

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* 31. Please upload your completed DMV Records Request form

PDF, DOC, DOCX file types only.
Choose File

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* 32. Please upload a color copy of your Drivers License

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File
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