Chancellor Volunteer Fire & Rescue

Application Packet

Chancellor Volunteer Fire & Rescue Department 5992 Plank Road Fredericksburg, VA 22407

CHANCELLOR VOLUNTEER FIRE AND RESCUE

MEMBERSHIP APPLICATION GUIDE

Welcome, and thank you for your interest in Chancellor Volunteer Fire and Rescue (CVFR). This application is the beginning of a exciting and rewarding career in public service. Fire and rescue professionals provide care to citizens in their greatest time of need. If you join CVFR, our commitment is to give you the opportunity, skills and support to become one of these dedicated community servants. By filling out this application, you will have completed the first step forward, from standing on the sidelines, to someone who can take action to help someone in danger.

CVFR holds a monthly membership night every fourth Wednesday, 7pm, at Company 10. Company 10 is located at 11201 Gordon Road, Spotsylvania, VA. At this time, applicants can meet with CVFR to complete many of the steps required to become a member. Once you submit your application, CVFR will contact you to schedule you for the next membership night.

The steps to becoming a CVFR member are as follows:

1. Submit an application to CVFR.

2. Applicants must be fingerprinted and pass a drug screen.

3. Applicants will be interviewed in person.

4. Applicants must submit three personal references and one reference from their employer (if employed).

5. Applicants will be presented in front of the CVFR membership at their monthly membership meeting.

The application allows CVFR to conduct a background check and driving record check on the applicant. The interview is conducted so that CVFR can get to know the applicant and provide an opportunity for applicants to ask any questions they have. Please see the attached reference guide for additional instructions on submitting references. Ultimately, CVFR membership will vote on each applicant during the monthly CVFR department meeting. This meeting occurs on the third Monday of each month. The meeting starts at 7:00 PM, and is held at Company 5. The address for Company 5 is 5992 Plank Road Fredericksburg, VA 22407 just across from Chancellor Elementary School. After becoming a member, new members will be scheduled for an orientation and CPR class. The orientation and CPR class is typically held the Saturday or Sunday following the monthly membership meeting. Applicants may also choose to begin some of the initial training that will be required after becoming a member, prior to joining. The training classes are online and can be found here: http://www.training.fema.gov/is/nims.aspx. The classes required are IS-100B, IS-200B, IS-700A and IS-800B.

FINGERPRINTING PROCESS

Fingerprints and the drug screen are available on the second Monday of every month between 5:30 PM and 7:30 PM at the Spotsylvania County Department of Fire Rescue and Emergency Management (FREM). FREM is located at the county public safety building, 9119 Dean Ridings Lane, Spotsylvania, VA 22553. Prior to attending during this time period, the applicant MUST make an appointment. Please contact Captain Greg Leitz at GLeitz@spotsylvania.va.us or (540) 507-7900 for scheduling. Alternatively, fingerprints are also available 9AM to 3 PM Monday – Friday at the Spotsylvania General District Court building. The court is located at 9111 Courthouse Road Spotsylvania, VA 22553-0339. The applicant must pick up a fingerprint card from CVFR or from FREM prior to going to the courthouse. Please plan to be at the court no later than 2:45PM to allow time to complete the fingerprinting. Therefore, if you need to pick up a fingerprint card, you should be at FREM no later than 2:30PM. The fingerprint card must be returned to Josie Adams at FREM after you have been fingerprinted. The drug screen can be scheduled during this period as well and is done at the public safety building. However, if the applicant needs to complete the drug screen during this period the applicant MUST make an appointment. Please contact Captain Greg Leitz at GLeitz@spotsylvania.va.us or (540) 507-7900 for scheduling. Drug screening can also be completed during the CVFR membership night.

CHANCELLOR VOLUNTEER FIRE & RESCUE DEPARTMENT Membership Application

Please mail or deliver this application, a copy of your driver's license, and accompanying documents to: Chancellor Volunteer Fire and Rescue, ATTN: Membership, 5992 Plank Road, Fredericksburg, VA 22407. Additionally, you can email the documents to membership@cvfr.net.

APPLICANT

Last Name First M.I. Date

Street Address Apt. #

City State ZIP

Home Phone Email

Cell Phone Firefighter EMT/Medic Ambulance Driver Administrative

BACKGROUND

Do you have a legal right to work in the United States? YES NO

Do you have a valid driver’s license? YES NO State Number

Have you ever been convicted of a crime? YES NO If yes, attach explanation

Have you ever been convicted of Driving While Intoxicated or Under the Influence? YES NO If yes, attach explanation

Have you ever been denied or terminated membership from a public safety agency? YES NO If yes, attach explanation

Have you ever been dismissed or forced to resign from any position? YES NO If yes, attach explanation

EDUCATION

High School Address

From To Did you graduate? YES NO Degree

College Address

From To Did you graduate? YES NO Degree

Other Address

From To Did you graduate? YES NO Degree

CERTIFICATIONS

List relevant certifications. Attach copies.

Certification Expiration

EMPLOYMENT

List most recent employment first.

Company Phone

Address

Position Supervisor

From To Reason for Leaving

Company Phone

Address

Position Supervisor

From To Reason for Leaving

Company Phone

Address

Position Supervisor

From To Reason for Leaving

EXPERIENCE

List all prior experience with volunteer fire, EMS, and other public safety organizations.

Agency Phone

Address

Position Chief

From To Reason for Leaving

Agency Phone

Address

Position Chief

From To Reason for Leaving

If you have additional experience, please attach.

REFERENCES

List three references. Do not include relatives or employers.

Full Name Phone

Address Relationship

Full Name Phone

Address Relationship

Full Name Phone

Address Relationship

STATEMENT

I hereby certify that every statement I have made on this application and supporting documents is true and complete. I understand that any false information or omission may disqualify me from further consideration for membership and may result in my immediate discharge if discovered at a later date. I understand that if this application is incomplete, it will not be processed.

I authorize the Spotsylvania County Department of Fire, Rescue & Emergency Management and this volunteer agency to investigate, without liability, all statements contained in this application and supporting materials. I also authorize references, employers, public safety agencies, and others, without liability, to make full response to any inquiries in connection with this application.

I understand that the use of illegal drugs is strictly prohibited and grounds for immediate termination. The use of alcohol or misuse of prescription drugs prior to or during duty is a serious violation punishable up to and including termination. I understand that I may be subject to random drug testing at any time.

My signature authorizes drug screening, investigative reports, criminal history and driving record checks, reference checks, and physical examination if required.

Signature Date

CHANCELLOR VOLUNTEER FIRE & RESCUE DEPARTMENT Attachment – Applicant Background Investigation

Please provide the following information and authorization to complete a mandatory applicant background investigation.

INFORMATION

Last Name First Middle

Date of Birth Soc. Sec. No. Gender

Driver’s License Number State

AUTHORIZATION

I authorize the Spotsylvania County Department of Fire, Rescue & Emergency Management and this volunteer agency to investigate, without liability, all statements contained in the membership application and supporting materials.

I also authorize references, employers, public safety agencies, and others, without liability, to make full response to any inquiries in connection with this application.

My signature authorizes drug screening, investigative reports, criminal history and driving record checks, reference checks, and physical examination if required.

Signature Date

Please complete the yellow highlighted sections of the following Virginia DMV Form CRD93

Chancellor Volunteer Fire & Rescue

CHANCELLOR VOLUNTEER FIRE AND RESCUE

REFERENCE SUBMISSION GUIDE

APPLICANT:

CVFR requires three personal references and one work reference. A personal reference is preferably someone who knows you well but to whom you are not related i.e. teacher, youth group leader, clergy, friend, etc. References can be mailed or delivered to Company 5 at 5992 Plank Road Fredericksburg, VA 22407, ATTN: Membership. The reference should contain the name and phone number of the person submitting the reference, and if possible, it should be signed. Additionally, references can be sent via email to membership@cvfr.net.

REFERENCE:

The person who gave this to you is applying to be a member with Chancellor Volunteer Fire and Rescue Department (CVFR). If selected, he or she will work with a team of citizens providing public safety services within Spotsylvania County, Virginia. Participants must be able to perform duties of an emergency nature in a stressful environment, which may require physical labor in all types of weather. In addition, participants must be motivated and dedicated to committing at least 36 hours per month, including overnight and weekend shifts. Participants are expected to complete numerous training courses that require note taking, independent study, and written and practical examinations.

In your written reference, please appraise the applicant’s assets and limitations in regard to the above conditions. In addition, attached are some general questions to consider answering in your reference. Your input is greatly appreciated.

1. What are the first words that come to mind to describe the applicant? 2. Please describe the applicant’s degree of maturity and independence. 3. Is the applicant professional and courteous? 4. Is the applicant usually on time? 5. How would you evaluate the applicant’s communication skills in regards to getting ideas across and

resolving conflict? 6. How do you think the applicant will handle manual labor? 7. Is this individual willing to try new things, meet new people and experience new things? 8. Please describe the applicant’s strengths. 9. Please describe the applicant’s weaknesses. 10. Would you have any reservation in recommending the applicant to participate with CVFR? Why or why

not? 11. Does the individual demonstrate the ability to be a team player? 12. Please include any additional information that you feel would help us to get to know the applicant and

determine if Fire and Rescue volunteering is a good fit for them.