Spotsylvania Volunteer Fire Department

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

Date

Time

AM/PM

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* 2. Applicant Information

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Email Address *

Phone Number *

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* 3. What is your Cellular Carrier

Verizon

T-Mobile/Sprint

ATT

Firstnet

If Other (please specify)

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* 4. Desired Role Selection & Health Screening

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* 5. Do you acknowledge that the position being applied for is entirely volunteer, and is not a paid county position?

Yes

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

Yes

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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”

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* 8. Do you or will you have any schedule obligation to any other EMS, Fire or related agency training, including items such as EMT school or other class while pursuing SVFD membership that may interfere with training?

Yes

If Yes, (please specify)

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

Yes

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* 10. If you answered “yes” for question #9 above, please specify with details, otherwise type N/A if you chose “no”

Background Information

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* 11. Social Security Number

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* 12. What is your current Age?

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* 13. What is your Date of Birth? (MM/DD/YYYY)

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* 14. Do you currently Possess a Valid Driver's License

Yes

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* 15. Enter Your Driver's License State of Issue (If you do not have one type "N/A)

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* 16. Enter Your Driver's License Number (If you do not have one type "N/A)

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* 17. Enter Your Driver's License Expiration Date (If you do not have one type "N/A)

Expiration Date

Date

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

Yes

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

Yes

If you selected Yes, Please Explain below

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

Yes

If you selected Yes, Please Explain below

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

Yes

If you selected Yes, Please explain below

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

Yes

If you selected yes, Please Explain below

Education (Most Recent First)

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* 23. College, University or Trade School

College/School Name

College/School Address

Degree Sought/Obtained

Number of Years Attended

Did You Graduate? (Yes or No)

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* 24. High School

High School Name

High School Address

Did You Graduate (Yes or No)

Certifications

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

Employment History

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* 26. Employment #1 (Most Recent First)

Company Name

Phone Number

Address

Position Held

Supervisor's Name

Date Hired

Date Resigned (If Current, type N/A)

Reason For Leaving (If Current, type N/A)

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

Company Name

Phone Number

Address

Position Held

Supervisor's Name

Date Hired

Date Resigned (If Current, type N/A)

Reason For Leaving (If Current, type N/A)

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

Company Name

Phone Number

Address

Position Held

Supervisor's Name

Date Hired

Date Resigned (If Current, type N/A)

Reason For Leaving (If Current, type N/A)

Volunteer Experience

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

Agency Name

Phone Number

Address

Position Held

Chief/Supervisor's Name

Date Hired

Date Resigned (If Current, type N/A)

Reason For Leaving (If Current, type N/A)

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

Agency Name

Phone Number

Address

Position Held

Chief/Supervisor's Name

Date Hired

Date Resigned (If Current, type N/A)

Reason For Leaving (If Current, type N/A)

Character & Professional References

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* 31. Reference #1

Full Name

Phone Number

Address

Email Address

Relationship

Years Known

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* 32. Reference #2

Full Name

Phone Number

Address

Email Address

Relationship

Years Known

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* 33. Reference #3

Full Name

Phone Number

Address

Email Address

Relationship

Years Known

Emergency Contact(s)

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* 34. Primary Emergency Contact

Name *

Relationship to Applicant *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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

Name *

Relationship to Applicant *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

Line of Duty Service Questions

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

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

Virginia DMV Records Request

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* 39. 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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* 40. Please upload your completed DMV Records Request form

PDF, DOC, DOCX file types only.

Choose File

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* 41. Please upload a color copy of your Drivers License (Or School ID If Junior Applicant)

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

Choose File

Spotsylvania Volunteer Fire Department

Candidate Application

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* 1. Date & Time Of Application

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* 2. Applicant Information

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* 3. What is your Cellular Carrier

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* 4. Desired Role Selection & Health Screening

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* 5. Do you acknowledge that the position being applied for is entirely volunteer, and is not a paid county position?

Question Title

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

Question Title

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

Question Title

* 8. Do you or will you have any schedule obligation to any other EMS, Fire or related agency training, including items such as EMT school or other class while pursuing SVFD membership that may interfere with training?

Question Title

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

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* 10. If you answered “yes” for question #9 above, please specify with details, otherwise type N/A if you chose “no”

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* 11. Social Security Number

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* 12. What is your current Age?

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* 13. What is your Date of Birth? (MM/DD/YYYY)

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* 14. Do you currently Possess a Valid Driver's License

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* 15. Enter Your Driver's License State of Issue (If you do not have one type "N/A)

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* 16. Enter Your Driver's License Number (If you do not have one type "N/A)

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* 17. Enter Your Driver's License Expiration Date (If you do not have one type "N/A)

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

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

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

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

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

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* 23. College, University or Trade School

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* 24. High School

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

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* 26. Employment #1 (Most Recent First)

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

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

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

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

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* 31. Reference #1

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* 32. Reference #2

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* 33. Reference #3

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* 34. Primary Emergency Contact

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

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

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

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