Membership application

Thank you for your interest in becoming a member of Waxhaw Volunteer Fire Department.

Please complete the following application. Someone from the Recruitment Team will contact you after receiving the application.

Waxhaw VFD Membership Application

First name *

Middle name

Last name *

Address *

Address

Street Address Line 1

Street Address Line 2

City

State/Province

Zip/Postal

Email *

Home phone

Cell phone

Prefered method of contact:

Home phone

Cell phone

Text Message

Date of birth *

Driver's License Number

Driver's license state issued

Drivers license class

Please check all Department aspects you are interested in: *

Volunteer Firefighting

Volunteer Emergency Medical Technician

Volunteer FF/EMTVolunteer FF/EMT

Firefighter Apprentice ProgramFirefighter Apprentice Program

Part-Time Paid Staff (requires previously obtained: NC FF Certification, NC EMS Certification)

Career Full-Time Paid Staff (requires previously obtained: NC FF Certification, NC EMS Certification)Career Full-Time Paid Staff (requires previously obtained: NC FF Certification, NC EMS Certification)

Junior Program (ages 16-18)

Auxiliary Team

Board Of Directors

Please list any prior Fire, Rescue, Emergency Medical Traing experience you have:

File Upload

Maximum upload size: 5MB

High school

School name

School city

School state

Date completed

Graduated?

College

School name

School city

School state

Date completed

Graduated?

Other Education

School name

School city

School state

Date completed

Graduated?

Military Experience

Branch of service

Reserve status

Attendance requirements

Employment History

Employer name

Employer's address

Employer's phone

Supervisor's name

Supervisor's phone

Supervisor's email address

Working hours

Date of hire

Specific job duties

May we contact your employer?

Personal References

List 3 people we may contact for a personal reference

Reference name

Reference phone

Reference email address

Reference address

Street Line 1

Street Line 2

City

State/Province

Zip/Postal

Country

Reference name

Reference phone

Reference email address

Reference address

Street Line 1

Street Line 2

City

State/Province

Zip/Postal

Country

Reference name

Reference phone

Reference email address

Reference address

Street Line 1

Street Line 2

City

State/Province

Zip/Postal

Country

List any criminal convictions and traffic violations:

reCAPTCHA

2023	Calls YTD	Avg response time
Jan	143	7:24
Feb	136	7:47
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Total YTD	279

Thank you for your interest in becoming a member of Waxhaw Volunteer Fire Department.

High school

College

Other Education

Military Experience

Employment History

Personal References

Motto

Contact Info

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Monthly Calls