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Botetourt County Emergency Services Services

CONTACT INFORMATION:   (use TAB key to move from box to box)

PLEASE COMPLETE THE FOLLOWING:

I would like to volunteer for:   FIRE     RESCUE   BOTH

I am interested volunteering with:  (choose only one)

Blue Ridge Buchanan Eagle Rock Read Mountain Glen Wilton

                                            Troutville Fincastle

THE FOLLOWING QUESTIONS ARE REQUIRED:

Currently in High School High School Graduate Some college/College Graduate

Have you ever been convicted of a felony? Yes No

Have you ever been the subject or party of a complaint with child protective services?

                                                      Yes      No

Have you ever been convicted of a traffic violation?   Yes  No

If you answered “YES” to any of the above three questions, please explain:

PLEASE LIST THREE REFERENCES (no relation, please):

1.

2.

3.

 

A criminal background check and DMV report is required for all volunteers. You will be contacted in person to provide your social security number and date of birth. Please give your best DAYTIME phone number so we may reach you.

      

Do you have a VA driver’s license?   yes      no               

 

How did you hear about Botetourt Emergency Services?

Recruited Web site Flyers/Advertising Friend Other

 

By pressing the “SUBMIT” button, I certify that I have completed this application to the best of my knowledge and ability. I certify the above information is true, complete and accurate. I also understand that I am giving permission to Botetourt County to run a criminal background check along with a Department of Motor Vehicles Report.