Kingsville Volunteer Fire Company

FIRE-EMS-RESCUE SERVICES

Thank you for your interest in joining the Kingsville Volunteer Fire Company. Everyday we take great pride in protecting and serving our community. Please read all of the information below before completing the application.

Membership Application

Please fill out everything on the application in its entirety and to the best of your ability.

If you are under 18 years of age, please make sure you have a parent or guardian sign the application and include a copy of your most recent report card.Have a parent or legal guardian attend orientation night in order to assist us in processing all necessary paperwork.

Please enclose a check, cash or money order payable to Kingsville Volunteer Fire Company for the amount of $75.00 at the time of application submission. This includes $18.00 for the background check,$20.00 for a company t-shirt, and$2.00as a processing fee; all of which are nonrefundable. The remaining$35.00 for the drug testwill be refunded pending a negative drug test as well as a successful completion of a 6 month probationary period.

All membership types will have a 1 year probationary period that must be successfully completed to obtain full membership within the company.

All classes specified in membership types are provided at no cost to applicant.

If you have any questions or concerns while filling out the application, or the application and probationary member process please contact Ashley Adams at 410-887-5773 and leave a message for the membership committee.

Kingsville Volunteer Fire Company

FIRE-EMS-RESCUE SERVICES

Fire Membership

Fire members are those that actively participate in firefighting and training activities.

Age:
Must be 16 years of age

  1. Training:
    Completion of the following training is required to ride fire equipment
  2. ICS 100,200,700,800
  3. Cardio-Pulmonary Resuscitation (CPR)
  4. HAZMAT Awareness
  5. Blood borne Pathogens
  6. Hepatitis vaccine series or signed waiver of non-intent
  7. Firefighter I course offered by the Baltimore County Fire Department or the Maryland Fire Rescue Institute (MFRI)
  8. Minimum Activities Required in each Calendar Year:
  9. Six (6) company business meetings
  10. Four (4) regularly scheduled company maintenance sessions.
  11. Six (6) maintenance sessions are required for ALL apparatus drivers
  12. Six (6) regularly scheduled company training sessions
  13. Thirty (30) hours of fund raising activities. Ten (10) hours of work details or committee work may be substituted for fundraising activities.
  14. Average of four (4) fire duties per month
  15. Benefits:
  16. Shall be entitled to a key to the fire house
  17. Shall be entitled to display the Maryland fire department license plate or company ID sticker
  18. Shall be entitled to wear company apparel
  19. Voting Eligibility:
  20. All regular company business
  21. All administrative officers
  22. Chief, Asst. Chief and Captain

Kingsville Volunteer Fire Company

FIRE-EMS-RESCUE SERVICES

Swiftwater Membership

Swiftwater members are those that actively participate in water rescues and training activities.

Age:
Must be 16 years of age

  1. Training:
    Completion of the following training is required to join as a swiftwater member
  2. ICS 100,200,700,800
  3. Cardio-Pulmonary Resuscitation (CPR)
  4. HAZMAT Operations
  5. Blood borne Pathogens
  6. Hepatitis vaccine series or signed waiver of non-intent
  7. Swiftwater rescue unit 1 and/or swiftwater advanced
  8. Minimum Activities Required in each Calendar Year:
  9. Three (3) company business meetings
  10. Two (2) regularly scheduled company maintenance sessions.
  11. three (3) regularly scheduled team training sessions
  12. Fifteen (15) hours of fund raising activities. Ten (10) hours of work details or committee work may be substituted for fundraising activities.
  13. Benefits:
  14. Shall be entitled to a key to the fire house
  15. Shall be entitled to display the Maryland fire department license plate or company ID sticker
  16. Shall be entitled to wear company apparel

Kingsville Volunteer Fire Company

FIRE-EMS-RESCUE SERVICES

EMS Membership

EMS members are those that actively participate in medical emergencies and training activities.

  1. Age:
    Must be 16 years of age
  2. Training:
    Completion of the following training is required to ride EMS equipment
  3. ICS 100,200,700,800
  4. Cardio-Pulmonary Resuscitation (CPR)
  5. Blood borne Pathogens
  6. HAZMAT operations
  7. Hepatitis series vaccine or a signed waiver of non-intent
  8. Emergency Medical Technician Basic (EMT-B)
  9. Completion of 4th's training supplied by EMS Lieutenant
  10. Minimum Activities Required in each Calendar Year:
  11. Six (6) company business meetings
  12. Four (4) regularly scheduled company maintenance sessions.
  13. Six (6) maintenance sessions are required for ALL apparatus drivers
  14. Six (6) regularly scheduled company training sessions
  15. Thirty (30) hours of fund raising activities. Ten (10) hours of work details or committee work may be substituted for fundraising activities
  16. Average of four (4) EMS duties per month
  17. Benefits:
  18. Shall be entitled to a key to the fire house
  19. Shall be entitled to display the Maryland fire department license plate or company ID sticker
  20. Shall be entitled to wear company apparel
  21. Voting Eligibility:
  22. All regular company business
  23. All administrative officers
  24. Chief and EMS Captain
  25. BLS Affiliation with the Company:
  26. Must be active with the company for a period of three (3) months or more before a MIEMSS affiliation will be granted
  27. Requirements for BLS affiliation
  28. 50% of the company business meetings in six (6) months
  29. 50% of the EMS trainings in six (6) months) months
  30. Must pass the EM
  31. S 3rd's training

Kingsville Volunteer Fire Company

FIRE-EMS-RESCUE SERVICES

Associate Membership

Associate members are those that actively support the company through fundraising, community service, and administrative positions. This membership type does not qualify personnel to respond on emergency calls.

  1. Age: Must be 16 years of age
  2. Training: None.
  1. Minimum Activities Required in each Calendar Year:
  2. Thirty (30) hours of fund raising activities. Ten (10) hours of work details or committee work may be substituted for fundraising activities.
  3. Benefits:
  4. Shall be entitled to a key to the fire house
  5. Shall be entitled to display the maryland fire department license plate or company ID sticker
  6. Shall be entitled to wear company apparel
  7. Voting Eligibility:
  8. All regular company business
  9. All administrative officers

Kingsville Volunteer Fire Company

FIRE-EMS-RESCUE SERVICES

Application Date ___/___/____ T-Shirt Size:______

Type of Membership(s)FIREEMSASSOCIATESWIFTWATER

Name (Last, First, Middle) ______

Address ______

______

Telephone: Home (___) ____-______Cell (___) ____-______Cell Service Provider ______

Social Security Number ____-___-_____E-mail ______

Driver’s License Number ______Class ____State ____Points _____

Date of Birth ___/___/_____Age ____

Emergency Contact ______

Address (number, street, city, state, zip) ______

Telephone Number ____-____-_____Relationship ______

V______(Membership Committee Only)

DOE ______(Membership Committee Only)
DOV ______(Membership Committee Only)

Kingsville Volunteer Fire Company

FIRE-EMS-RESCUE SERVICES

Current Employer ______Phone Number ____/____/_____

Address ______

______

Supervisor’s Name and Contact number ______

Employment Dates ______to ______

References: Give the names of three people not related to you, whom you have known for at least two years. (Name, Full Address, Phone Number)

______

______

______

Are you currently a member of any other Fire, EMS, or Rescue Company?YESNO

If yes where: ______

Have you ever previously belonged to or applied to any other Fire, EMS, or Rescue Company?

YESNOIf yes where: ______

Have you ever been rejected, suspended, or expelled from this and or any other volunteer Fire, EMS, or Rescue Company? YES NO If yes, please explain ______

______

______

Kingsville Volunteer Fire Company

FIRE-EMS-RESCUE SERVICES

Please list any certifications or licensures that you currently hold along with any expiration dates.

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

Kingsville Volunteer Fire Company

FIRE-EMS-RESCUE SERVICES

Have you ever been arrested or in the custody of any law enforcement due to a crime or a delinquent act resulting in charges of any sorts? (If yes please explain and provide pertinent information including the year)

______

______

______

______

Have you ever been convicted of a criminal act or currently have pending charges? (If yes please explain and provide pertinent information regarding the situation)

______

______

______

______

Kingsville Volunteer Fire Company

FIRE-EMS-RESCUE SERVICES

Briefly explain what interested you in joining the Kingsville Volunteer Fire Company and any goals you have within the fire service.

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

Kingsville Volunteer Fire Company

FIRE-EMS-RESCUE SERVICES

Please read the following statement carefully before signing

I hereby authorize the Kingsville Volunteer Fire Company to investigate all statements contained in this application. To the best of my knowledge, all statements and answers, which I have given, are true, accurate, and correct. I understand that a misrepresentation or omission of the facts may result in nullification of this application or subsequent membership based upon its contents.

Full Signature: ______Date: ______

NOTE: All applicants under the age of 18 years of age must turn in a copy of their most recent report card, a work permit, and have consent of their parents or legal guardian.

I give consent for the above applicant to participate in the activities of the Kingsville Volunteer Fire Company.

Signature of Parent/Guardian: ______Date:______

Kingsville Volunteer Fire Company

FIRE-EMS-RESCUE SERVICES

Please read the following statement carefully before signing

All applicants applying for membership in the Kingsville Volunteer Fire Company must have a drug test, which will be supplied through the fire company. This test must occur within 72 hours after orientation with the Membership Committee. If the test returns drug free, you will be accepted into the company and will begin your six month probationary period. At the end of your probation period, if you are voted in you will receive your refund of $35.00.

Full Signature ______Date ______

NOTE: All applicants under the age of 18 years of age must have the signature of the parent or legal guardian for drug testing.

I give consent for the above applicant to have drug testing through the Kingsville Volunteer Fire Company.

Signature of Parent/Guardian ______Date ______

Kroll Background America

AUTHROIZATION AND RELEASE FOR THE PROCUREMENT OF A

CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT

I, the undersigned consumer, do hereby authorize KINGSVILLE VOLUNTEER FIRE DEPT. (“KVFD”), by and through its independent contractor, KROLL BACKGROUND AMERICA, INC. (“KBA”), to procure a consumer report and/or investigative consumer report on me.

These above mentioned reports may include, but are not limited to, information as to my character, general reputation, personal characteristics and mode of living, discerned through employment and education verifications, personal references, personal orientations, my personal credit history based on reports from any credit bureau, my driving history, including any traffic citations, a social security number verification, present and former addresses, criminal and civil history/records, or any other public records.

I understand that I am entitled to a complete and accurate disclosure of the nature and scope of any investigative consumer report of which I am the subject upon my written request to KBA, if such is made within a reasonable time after the date hereof. I also understand that I may receive a written summary of my rights under 15 U.S.C 1681 et. Seq.

I further authorize any person, business entity or governmental agency who may have information relevant to the above to disclose the same to KVFC, by and through KBA, including, but not limited to, any and all courts, public agencies, law enforcement agencies and credit bureaus, regardless of whether such person, business entity or governmental agency compiled the information itself or received it from other sources.

I hereby release KVFD, KBA and any and all persons, business entities and governmental agencies, whether public or private, from any and all liability, claims and/or demands by me, my heirs or others making such claim or demand on my behalf, for providing a consumer report and/or investigative consumer report hereby authorized. I understand that this Authorization/Release form shall remain in effect for the duration of my employment with KVFD.

Further, I certify that the information contained on this Authorization/Release form is true and correct and that my application for employment will be terminated based on any, omitted or fraudulent information.

Signature: . Date: .

Print Name: First MiddleLast Other names Used/Dates Used

Street/P.O. Box City State Zip codeDate

Addresses for the Past Seven Years:

Street/P.O. Box City State Zip codeDate

Street/P.O. Box City State Zip codeDate

Social Security Number: - - -Daytime Telephone Number: ( ) - .

Driver’s License Number: . State of Issuance: . Date of Birth: / / .

  • Have you ever been convicted of a crime or convicted in a military court martialYes . No .
  • Have you ever been sanctioned or had your license suspended or revoked?Yes . No .
  • Are your currently under any investigation or pending charge?Yes . No .

This information will enable us to properly indentify you in the event we find adverse information during the course of our background search.

This page is intentionally blank.