Complete the Volunteer Application Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress 1 *Address 2City *State *Zip *Phone *Email *Preferred Method of Contact *Phone CallText MessageEmailAge *Date of Birth *High Education Level Completed *Middle School9th Grade10th Grade11th Grade12th GradeGEDAssociates DegreeBachelors DegreeMasters DegreeDoctorateAre you Currently a Student? *YesNoIf YES to above question, what school(s)Are you or have you been affiliated with ANY Fire or Rescue agencies? *YesNoIf YES to above question, then who?If YES, then may we contact your supervisor(s) from these agencies?YesNoAre You Currently Employed? *YesNoIf YES please list your employer(s) and position(s)Employer(s) Address, City, State, and Phone if Applicable:Have you ever been convicted of a law violation(s), including moving traffic violations? *YesNoIf YES, list ALL and explain:How did you hear about Staunton-Augusta Rescue Squad? *Do you know anyone affiliated with Staunton-Augusta Rescue Squad? *YesNoIf YES , please list their names here:Use this space for any additional information that you think would help us evaluate your application, including training, seminars, workshops, special achievements, or specialized skills.What position are you applying for? (select all that apply) *Junior (age 16-21)Full (48 hours a month attend quarterly business meeting/monthly junior meeting and maintain EMT EVOC and CPR)Senior (must be 21 years or older)Associate (24 hours a month maintain EMT EVOC and CPR)AuxiliaryType Your Full Name *I hereby certify that all entries on this application are true and correct. I also understand that all information is subject to verification and give my consent for representatives of The Staunton-Augusta Co. First-Aid and Rescue Squad to check such information that I have presented. I further authorize the use of such information received for consideration of membership (by typing your name below and initialing you are agreeing to these terms): Initial Here (separate each with a period) *Today's Date *Submit
