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:______________________