Orchard Beach Volunteer Fire Dept
Membership Application
All Applicants Are To Bring All Fire Dept Related Training Records And A Non-Certified Copy Of There Current Driving Record Thru The MVA. Failure To Provide Such Information At The Time Of Interview Will Delay Your Interview Process For As Much As 30 Days.
Type of Membership requested (check one): Active_______ Associate________ Cadet_______
Name:_________________________________ Age:_________ Date of Birth____________
Address:_______________________________ Social Security #:______________________
________________________________
Home Phone #:__________________________ Work Phone #:_________________________
Pager or Cell Phone #:____________________ E-Mail Address :________________________
Parent/Guardian Name and Address (only if under the age of 18)______________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Have you ever been a member of any other Fire Dept Yes / No (List)____________________________
If already on any volunteer database for Anne Arundel County place badge # here: _______________________
Drivers License #____________________ State_____ Class_______ # of points on record________
Emergency Notification Name:_____________________ Phone #_____________________________
Address:_______________________________________ Relationship:________________________________
________________________________________
Parent/Guardian Signature (if under 18 years of age)______________________________________
Applicants Signature:___________________________________ Date:_________________________
Note: Any false information or failure to complete application in full, will result in the termination of the application process
Committee Members Signatures: 1)______________________ Date of Interview_____________
2)______________________ Membership Start Date:________
3)______________________ Probation Ending Date:_________
Physical Papers Sent To County Date:____________________
Physical Papers Returned Date:_________________________
Physical Papers Given To Member Date:__________________ Assigned To A Bingo Crew:________
Received By Training Department:_______________________ Badge # Assigned:___________
Received By The Secretary:____________________________ Resignation Date:__________
Received By The Chief/Asst Chief:______________________