Lison Volunteer Fire Company
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Lisbon Volunteer Fire Co Membership Application

Thank you for your interest in joining the Lisbon Volunteer Fire Company. Please complete the application below and our membership committee will contact you to set up an interview. Once your application is submited you will recieve an email confirmation. If you have any questions please contact our membership committee at joinus@lisbonvfc.org.

 

Required   Indicates Required Field
Personal Information
Name:
Last, First, Middle
Required
Address: Required
City/State: Required
Zip Code: Required
Has this been your residence for the last 5 years?: Required Yes
No
If no, where did you reside?:
Home Phone:
Cell Phone:
Work Phone:
Email: Required
Preferred Method of Contact: Required
Date of Birth: Required
Sex: Required Male
Female
Age: Required
Marital Status: Required
Height: Required
Weight: Required
Hair Color: Required
Eye Color: Required
Are you a citizen of the United States?: Required Yes
No
Resident Foreign National
Non-Resident Foreign National
Ethnicity: Asian
American Indian or Alaskan Native
Black or African American
Hispanic or Latino
Native Hawaiin or Pacific Islander
White
Other
Occupation: Required
Duties:
Employer Name: Required
Employer Address: Required
Have you ever served in the armed forces?: Required Yes
No
If Yes, which branch?:
Type of Discharge:
Do you a history of any of the following?: Required Respiratory Distress
Epilepsy or Seizures
Heart Disease
Asthma
None
Previous History of any medical problem that will impair your service in this department: Required Yes
No
Have you ever been convicted (Felony or Misdemeanor) of any violation of the law, excluding minor traffic violations?: Required Yes
No
If Yes, please describe:
Please include the date, court, and disposition of the case, and include any cases in which you were given probation before judgment (or a similar finding in a state other than Maryland) (Conviction of a crime is not cause for an automatic barring to membership. Each case is considered on its own merit. Persons with record(s) of arrest and convictions may hold membership within this department.)
Drivers License No: Required
State of Issue:
License Class:
Date of Issue:
Expiration Date:
Have you ever held a drivers license in another state?: Required Yes
No
If Yes:
State, License No, Class
Experience
Have you ever been a member of this or any other fire department?: Required Yes
No
If Yes, Name of Department:
You must submit a letter of recommendation from a chief officer.
Are you planning on maintaining dual membership?: Yes
No
If the other station is in Howard County select a "Home Station":
Have you ever had any previous firefighting or emergency medical training?: Required Yes
No
If Yes, Please explain and list any certifications and dates taken:
Attach copies to this application
Have you ever been rejected, suspended, or expelled from this or any fire department or rescue group?: Required Yes
No
If Yes, Please Explain and What Department:
Why would you like to be a member of the Lisbon Volunteer Fire Company?: Required
How did you hear about us?:
Emergency Contacts
1st Emergency Contact Name: Required
1st Emergency Contact Relationship: Required
1st Emergency Contact Phone No: Required
1st Emergency Contact Address: Required
2nd Emergency Contact Name: Required
2nd Emergency Contact Relationship: Required
2nd Emergency Contact Phone No: Required
2nd Emergency Contact Address: Required
References
Reference 1 Name:
One Reference can be a member of the department
Required
Reference 1 Phone: Required
Reference 2 Name: Required
Reference 2 Phone: Required
Are you applying to be an Active (operational) or Sustaining (administrative) member?: Required Active
Sustaining
Attach any additional documentation to your application:
Add files...
By clicking submit you agree to:
I do promise to abide by all laws and rules relating with the Lisbon Volunteer Fire Company, Inc.
I, the undersigned, will be required to appear before the membership committee for an initial interview.
I, the undersigned, understand that should my application for membership be accepted by the members of the LVFC, I shall be on a 365 day probation period.
I, the undersigned, understand that any knowingly false statement to any of the foregoing herein will result in the rejection of the application for membership or possible termination if membership was already granted.
Type your name to sign your Application: Required
If under 18 provide name and number of a Parent/Guardian:




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Lisbon Volunteer Fire Co.
P.O. Box 40
Lisbon, MD 21765


Lisbon Volunteer Fire Co.
16104 Frederick Road
Woodbine, MD 21797


Emergency Dial 911
Station: 410-489-4646
E-mail: info@lisbonvfc.org
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