Apply Online

Botetourt County Emergency Services

A criminal background check and DMV report is required for all volunteers. You will be contacted in person to give your social security number. Please be sure to give your daytime phone # (above) so we may contact you.

By pressing the above “SUBMIT” button, I certify that I have completed this application to the best of my knowledge and ability. I certify that 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 and DMV report.

Please complete the following application. Fill in all appropriate blanks and select best answer where applicable.

Use the “TAB” key between the boxes.

Full Name

Street Address

City

Zip Code

Home Phone

Cell Phone

I would like to volunteer for:

Select the dept. you are interested in joining:

Highest Education

Have you ever been convicted of a felony?

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

Do you have any traffic violations?

If "Yes" to any above, please explain:

Date of Birth

Choose One

Do you have a VA driver's license?

1. Reference Name and Phone #

2. Reference Name and Phone #

3. Reference Name & Phone #

Daytime phone # (required):

How did you hear about Botetourt EMS?

Click here to start over or clear:

Please read the following and click submit if you agree: