Apply Online Today!

You can now apply to become a member of Chancellor Volunteer Fire & Rescue online.

Please review our application guide before filling out this application and please contact us if you have any further questions.

If you would prefer to apply the old fashion way…. Click here to download a printable application.

 

CVFR

Chancellor Volunteer Fire & Rescue Application



Applicant

 

Last Name

First Name

Middle Initial

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Email Address

Position

 


Background

 

Do you have a legal right to work in the United States?

 

Do you have a valid drivers license?

 

Have you ever been convicted of a crime?

 

If “Yes”

 

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

If “Yes”

 

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

If “Yes”

 

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

If “Yes”

 


 

Education

 

High School

Address

Did You Graduate?

Degree

 

College

Address

Did You Graduate?

Degree

 

Other

Address

Did You Graduate?

Degree

 


 

Certifications

 

List relevant certifications and attach copies.

 

 

 

 


 

Employment

List most recent employment first.

 

Company

Phone Number

Address

Position

Supervisor

Reason for Leaving

 

Company

Phone Number

Address

Position

Supervisor

Reason for Leaving

 

Company

Phone Number

Address

Position

Supervisor

Reason for Leaving

 


Experience

List all prior experience with volunteer fire, EMS, and other public safety organizations.

 

Agency

Phone Number

Address

Position

Chief

Reason for Leaving

 

Agency

Phone Number

Address

Position

Chief

Reason for Leaving

 

Additional Experience

 


 

 

References

List three references. Do not include relatives or employers.

 

Full Name

Phone Number

Address

Relationship

 

Full Name

Phone Number

Address

Relationship

 

Full Name

Phone Number

Address

Relationship

 


 

DMV Information Request

Please download the following forms, complete them in their entirety, and upload copies below. PLEASE also include a copy of your valid Driver’s License.

Driving Record Transcript Authorization

DMV Information Request Form

 

 


 

How did you find us?

How did you hear about Chancellor Volunteer Fire and Rescue?

If “Other” please list here

 


 

Statement

 
I hereby certify that every statement I have made on this application and supporting documents is true and complete. I understand that any false information or omission may disqualify me from further consideration for membership and may result in my immediate discharge if discovered at a later date. I understand that if this application is incomplete, it will not be processed.
 
I authorize the Spotsylvania County Department of Fire, Rescue & Emergency Management and this volunteer agency to investigate, without liability, all statements contained in this application and supporting materials. I also authorize references, employers, public safety agencies, and others, without liability, to make full response to any inquiries in connection with this application.
 
I 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.
 
My signature authorizes drug screening, investigative reports, criminal history and driving record checks, reference checks, and physical examination if required.
 

 

 

Leave this empty:

Signature Certificate
Document name: Chancellor Volunteer Fire & Rescue Application
Unique Document ID: d6dfe31621d1e967948cbd4c8e3b768cec5a3c0c
Timestamp Audit
January 26, 2016 8:00 pm ESTChancellor Volunteer Fire & Rescue Application Uploaded by Chancellor Volunteer Fire & Rescue - membership@cvfr.net IP 98.249.23.146