Second District Volunteer Fire Department and Rescue Squad, Inc.

Second District Volunteer Fire Department and Rescue Squad, Inc.

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2019 Run Stats
Fire EMS
Jan 38 97
Feb 36 105
Mar 40 114
Apr 27 141
May 15 74
Jun 0 0
Jul 0 0
Aug 0 0
Sep 0 0
Oct 0 0
Nov 0 0
Dec 0 0
Total 156 531

Past Incidents
Fire EMS
2011 300 898
2012 319 798
2013 280 814
2014 338 881
2015 348 1057
2016 423 1164
2017 443 1138
2018 400 1303

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April 28, 2016
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Membership Application

Membership Application for the Second District Volunteer Fire Department and Rescue Squad

 

Please print and bring the Background Consent/Release Form with you to the membership meeting.

Upon submitting this application, you will be contacted by a member of the Membership Committee.

Required   Indicates Required Field
Date: 05/26/2019 0253
Full Name:
First, Middle, Last Name
Required
Home Phone:
Cell Phone:
Email Address:
Address:
Street Address, City, State, Zip Code
Required
How long have you lived at this address?: Required
Social Security Number:
Date of Birth: Required
Age: Required
Do you have a high school diploma or GED?: Required
Name of School: Required
Location of school:
Month / Year Graduated:
Marital Status:
(Optional)
Required
Employer: Required
Employer Address:
Street address, City, State, Zip Code
Work Hours:
Work Phone:
Next of Kin: Required
Relationship: Required
Phone Number: Required
Do you have any handicaps or medical conditions: Required
If Yes, Explain:
Have you ever been arrested?: Required
If Yes, explain in detail:
Have you been in the Military Services?: Required
If so, what type of discharge did you receive?:
Have you ever been a member of a volunteer Fire Department or Rescue Squad?: Required
If previous member in Maryland, provide LOSAP Number:
Attach LOSAP records:
If you have your county LOSAP records, please attach them here.
Add files...
Name of Department:
Department Address:
Street Address, City, State, Zip Code
Chief Officer:
Have you ever had any prior training in Firefighting or First Aid?:
If so, please attach copies of training records
Required
Training Records:
Please attach any training records you have
Add files...
Do you have a Maryland drivers license?: Required
Driver's License Number:
License Class:
Has your license ever been suspended or revoked?: Required
If license has been suspended or revoked, please explain:
Membership Status you are applying for:
Note: If you are between the ages of sixteen (16) and eighteen (18), you will serve as a Junior Member until you reach your eighteenth (18) birthday. You must have parental consent to join. All members must serve a nine-month probationary period before being voted as an active member by the membership.
References (Please list three (3) personal references who are not relatives)
Reference #1:
Name, Address, Phone Number
Required
Reference #2:
Name, Address, Phone Number
Required
Reference #3:
Name, Address, Phone Number
Required
Remarks:
Applicant Electronic Signature:
I understand that signing the electronic signatures constitutes a legal signature confirming that I acknowledge and agree to the terms of the application.
Required
Date Application Submitted: 05/26/2019 0253
Parent/Guardian Signature:
If you are between the ages of Sixteen (16) and Eighteen (18), you will serve as a Junior Member until you reach your Eighteenth (18th) Birthday. You must have parental consent to join. Parent/Guardian may be required to attend membership meeting and actual signature will be required.
Parent/Guardian Date Signed:
I hereby acknowledge the receipt of ByLaws of this organization:
Date of ByLaws received:

I understand that signing the electronic signatures above constitutes a legal signature confirming that I acknowledge and agree to the Terms of the application below.


If accepted as a member, I will abide by the ByLaws and upon termination of my membership I will return any and all property belonging to the Second District Volunteer Fire Department and Rescue Squad.  

I authorize the investigation of all statements contained in this application.  I understand that misrepresentation or omission of factions called for is cause for non-acceptance or dismissal.  Further, I understand the requirements and duties of being a member of the Second District Volunteer Fire Department and Rescue Squad, Inc. and agree that the failure to meet or fulfill these requirements, are reason for dismissal or other actions.  I further certify, if under the age of 18, I have permission of my parents or guardian to join the Second District Volunteer Fire Department and Rescue Squad, Inc.

Note: If you are between the ages of Sixteen (16) and Eighteen (18), you will serve as a Junior Member until you reach your Eighteenth (18th) Birthday.  You must have parental consent to join.  All members must serve a nine-month probationary period before being voted as an active member by the membership.

 

 

 





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Second District Volunteer
Fire Department & Rescue Squad

45245 Drayden Road
P.O. Box 1
Valley Lee, Maryland 20692
Emergency Dial 911
Non-Emergency: 301-994-0751
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