Dale City Volunteer Fire Department


	Guestbook
	View the Guestbook View Archive
	Join
	Responsibilities Training Cadets Apply Online Mail the Forms
	About
	About the Department Station Locations DCVFD Auxiliary About this site
	Training
	Prince William Co. Training
	Links [Add a Link]
	Prince William Co. Depts Departments by State Memorials, Museums, etc. Directories Apparatus Manufacturers Equipment Manufacturers

Online Application for Membership to the
Dale City Volunteer Fire Department

This application is to submit your information to our board of directors and membership committee for membership in the Dale City Volunteer Fire Department. A copy of your driving record and your criminal record will also be required. PLEASE READ BEFORE FILLING OUT THIS FORM

Last:

First:

Middle:

I learned about DCVFD from (Mark appropriate box):
STA. NO.	POTOMAC MILLS THEATRES	FUND RAISER
SCHOOL (Name?)	OTHER

Please complete form. Make sure you include City, State, and ZIP in the home address portion.

PERSONAL INFORMATION

Date of Birth:		Sex:	Male Female
Home Address:			Phone: Email:

EMPLOYMENT INFORMATION

Current Employer		Length years
Business Address
Phone

Previous Employer		Length years
Business Address
Phone

EMERGENCY NOTIFICATION

Name
Relationship
Phone
Address

PERSONAL LOCAL REFERENCES

Name
Address
Phone

Name
Address
Phone

Name
Address
Phone

LIST PREVIOUS FIRE OR RESCUE TRAINING YOU HAVE RECEIVED AND THE LOCATIONS YOU RECEIVED SUCH TRAINING (be sure to have copies of certificates):

Course	Department/State (i.e. Rescue Co. 1/VA)	Date Completed

ARE YOU OR HAVE YOU EVER BEEN A MEMBER OF A PRINCE WILLIAM VOLUNTEER DEPT.? If yes:

Name of Dept.	Dates	Reason for Leaving
	to
	to

If you were a DCVFD member, complete the following:
Member from to

Station: Battalion: Officer:

Please indicate which of the following categories you are primarily interested in:

Fire Rescue Both Fire and Rescue Associate

Have you ever been charged with any violation or infraction of the law (include traffic offenses)?

Yes No

If the answer to the above question is Yes, please list the date(s), offense(s), and location(s) below:

Date	Offense	Location	Disposition

Are you on disability that prohibits you from working? If so, state why.

Type DCVFD in the box below before submitting form:
(Application WILL NOT be received if DCVFD is not typed in the box.)

Return to Becoming a Member

All Content, Images, and Layout of this site are © Dale City Volunteer Fire Department 1999-2007.
Use or reproduction without expressed written consent is forbidden.
Send site related comments or questions to the webmaster.