HARTFIELD VOLUNTEER
FIRE DEPARTMENT
HVFD HOME
ABOUT
CURRENT EVENTS
SERVICES
RESOURCES
RESOURCES
Weather Forecast
Homeowners Insurance Questions
MIDDLESEX COUNTY Phone Numbers
VOLUNTEER
CONTACT
HVFD HOME
ABOUT
CURRENT EVENTS
SERVICES
RESOURCES
RESOURCES
Weather Forecast
Homeowners Insurance Questions
MIDDLESEX COUNTY Phone Numbers
VOLUNTEER
CONTACT
Hartfield Volunteer Fire Department Application
MEMBERSHIP TYPE
FIREFIGHTER
ASSOCIATE MEMBER
AUXILARY MEMBER
Personal Information
Personal Information
MI
Suffix
None
Senior
Junior
lll
Address
City
Zip Code
Social Security #
Phone
Date of Birth
Email
Employer Information
Education
High School / GED
Some College
College Degree
Technical / Professional
Degree / Technical / professional
Do You Have Any Physical Limitations, which would interfere in the performance of any duties
YES
NO
If Yes Explain
If Requested Do You Agree To Submit Documentation From Your Physician That You are Medically Cleared
YES
NO
Have You Ever Been Convicted of a Felony or Misdemeanor
YES
NO
If Yes
Misdemeanor
Felony
Explain
Do You Agree To The Following
Background Check
DMV Records Release
No Do Not Agree To Background Check
No Do not Agree To DMV Records Release
Past Experience If Any / Please Include Agency / Your Position / Contact Name and Number
Emergency Contact / Name / Relationship / Phone # ( can have more than one contact)
How Did You Hear About Us
HVFD Member
Social Media
Website
Signature
Date
Accept
I understand and agree that submitting this application form does not automatically register me as a volunteer
There may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I begin volunteering
By submitting this form, I attest that the information I have provided on the form is true and accurate.
It is the policy of Hartfield Volunteer Fire Department Inc. not to discriminate against and applicant because of age, color, sec. disability, national origin, race, religion, or veteran status
Submit
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3309 Twiggs Ferry Rd, Hartfield,VA 23071 USA | Phone: 804-776-6880 | Email: hvfdadmin@breezeline.net