MGVFC Membership Application

What Type of Membership are you Applying for?(Required)

Name(Required)

Email(Required)

Phone(Required)

Address(Required)

How long at current address?(Required)

Gender(Required)

Date of Birth(Required)

Age(Required)

Are You Currently Employed?(Required)

Yes

Where are you Employed?(Required)

Have you ever been convicted of a traffic offense, misdemeanor, or felony?

No, I have not been convicted of anything

Yes, Traffic Offense

Yes, Misdemeanor

Yes, Felony

Please list the charge, jurisdiction, and disposition.(Required)

Have you ever been a member of any other Fire or EMS organization?(Required)

Yes

Which Fire or EMS Organization?(Required)

Organization Name

Years Served

More than one? Please use the "+" sign to add.

Please list any Fire or EMS certifications you currently hold.

One certificate per line, please use the "+" sign to add more.

References

Please provide two references can not use family members

Reference #1 Name(Required)

Reference #1 Relationship(Required)

Reference #1 Name(Required)

Reference #1 Email(Required)

Reference #1 Phone(Required)

Reference #2 Relationship(Required)

Reference #2 Name(Required)

Reference #2 Email(Required)

Reference #2 Phone(Required)

Deceleration #1(Required)

I the undersigned, certify by my initals that I have read and fully comprehend this form in it's entirety and that the information herein provided is true and complete to the best of my knowledge. I understand that, should any statement I have made prove to be false, misleading or erroneous, it may result in the rejection of my application or my discharge from the Maugansville Goodwill Volunteer Fire Company.

MAUGANSVILLE

GOODWILL VOLUNTEER FIRE COMPANY

We Look Forward to Having you Join our Family

References

MAUGANSVILLE GOODWILL VOLUNTEER FIRE COMPANY

Phone