This is an official application for membership into the Athens Volunteer Fire Department. Knowingly providing false or misleading information on this form is considered grounds for immediate refusal, or termination of membership provided it is accepted beforehand. You may either submit this form below electronically, or click here to fill out and print a paper copy for mailing. You will be required to sign your application on your first meeting night.

Junior Membership Permission.

If you are applying for membership and have not yet reached the age of 18, you must have parental permission. No one under the age of 16 is permitted to submit an application. In accordance with West Virginia State Law, you must reach the age of 18 before you can be certified as a firefighter. Howerever, you may start your certification training, and acquire your mandated "in-house" training time while being recognized as a junior firefighter. If you are interested in Junior Firefighter membership, please contact Derek Belcher, Captain (304) 887-4868

Personal Information

First Name Last Name M.I.

Current Address City State

Are you a Concord University Student? YES NO

What is your campus address: Dormitory / Building Campus Box

Telephone Number Cellular Number

Date of Birth * You must be 18, or reach the age of 18 to obatain Firefighter Status

Do you have a valid drivers license? Yes No | Number State of Issue

Do you have valid vehicle issurance? Yes No

Answering Yes to any question below, requires an explanation. Athens Volunteer Fire Department is an equal opportunity organization, and does not discriminate. Due to the nature of this profession, some individuals with severe handicaps may not be able to perform the necessarry tasks of this organization.

Do you have any physical impairment? No Yes, Please Explain:

Do you have any medical problems? No Yes, Please Explain:

Do you have any drug allergies / sensitivities? No Yes, Please List all allergies:

Do you have any firefighting experience / training? No Yes, Please Explain:

Employment / Reference Information

Current Employer: May we obtain a reference? Yes No

Supervisor Phone

References: Please DO NOT list anyone who is a relative, or affiliated with this fire department

Name Address Phone
 

Additional Information

Please list any additional information, skills, or other that you feel makes you a quality candidate for membership.

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