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 receive an email confirmation. If you have any questions please contact our membership committee at joinus@lisbonvfc.org.

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Personal Information
Name: Last, First, Middle
Address:
City/State:
Zip Code:
Has this been your residence for the last 5 years?:		Yes No
If no, where did you reside?:
Home Phone:
Cell Phone:
Work Phone:
Email:
Preferred Method of Contact:		Select Below Home Phone Cell Phone Work Phone Email
Date of Birth:
Sex:		Male Female
Age:
Marital Status:
Height:
Weight:
Hair Color:
Eye Color:
Are you a citizen of the United States?:		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:
Duties:
Employer Name:
Employer Address:
Have you ever served in the armed forces?:		Yes No
If Yes, which branch?:
Type of Discharge:		Select Below Honorable Dishonorable Administrative Medical General Bad Conduct
Do you a history of any of the following?:		Respiratory Distress Epilepsy or Seizures Heart Disease Asthma None
Previous History of any medical problem that will impair your service in this department:		Yes No
Have you ever been convicted (Felony or Misdemeanor) of any violation of the law, excluding minor traffic violations?:		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:
State of Issue:		Select Below AL AK AZ AR AS CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
License Class:
Date of Issue:
Expiration Date:
Have you ever held a drivers license in another state?:		Yes No
If Yes: State, License No, Class
Experience
Have you ever been a member of this or any other fire department?:		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":		Select Below 1 - Elkridge 2/8 - Ellicott City 3 - West Friendship 4 - Lisbon 5 - Fifth District 6 - Savage
Have you ever had any previous firefighting or emergency medical training?:		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?:		Yes No
If Yes, Please Explain and What Department:
Why would you like to be a member of the Lisbon Volunteer Fire Company?:
How did you hear about us?:
Emergency Contacts
1st Emergency Contact Name:
1st Emergency Contact Relationship:
1st Emergency Contact Phone No:
1st Emergency Contact Address:
2nd Emergency Contact Name:
2nd Emergency Contact Relationship:
2nd Emergency Contact Phone No:
2nd Emergency Contact Address:
References
Reference 1 Name: One Reference can be a member of the department
Reference 1 Phone:
Reference 2 Name:
Reference 2 Phone:
Are you applying to be an Operational or Non-Operational (administrative) member?:		Operational Non-Operational
Attach any additional documentation to your application:		Add files...
By clicking submit you agree to the following statements:
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:
If under 18 provide name and number of a Parent/Guardian: