Membership application

First name

Last name

Phone

Birthday

Month

Day

Year

Social Security Number

Gender

Multi-line address

Country/Region

Address

City

Zip / Postal code

Position of Interest

Please select the position that best fits your interests. You do not have to be certified in any of the areas you are interested in at the time of application.

Please list any current member of the AVFD who assisted in recruiting you to the department. If this does not apply please leave blank.

Previous Fire or EMS Service

Have you ever served on another fire department or EMS agnecy?

If so, what was the last postion you held?

Are you still currently a member of this fire department or EMS agency?

Name of your last fire department or EMS agency you served with

Primary Employer Information

Primary Occupation

Employer Phone

Primary Employer

Employer Address

Describe your normal work hours

Check this box if you have more than one job.