Blacksburg Volunteer Fire Department Application

The following information must be provided by or will be obtained on behalf of all applicants: 1. Social Security Number 2. Criminal History Check

Indicates Required Field

Personal Information
Membership Type:		Firefighter Support Recruit Firefighter
Last Name:
First Name:
Middle :
Suffix:
Street Address:
City:
State:
ZIp Code:
Email Address:
Phone Number:
Alternate Number:
Marital Status:		Select Below Single Married Divorced
Date of Birth:
Social Security Number: Needed for Background Check through South Carolina State and SC Fire Acadmey
Birthplace:
U.S. Citizen:		Yes No
Drivers License Number:
State Issued:
Have you ever been convicted of a traffic violation:		Yes No
If yes, please explain the charge and disposition:
Have you ever been arrested, summoned into court as a defendant or indicted, convicted, fined, imprisoned, or placed on probation, or has any case been filed against you?:		Yes No
If yes, please explain:
Education
Present Employer (Please include Address, Phone Number, Immediate Supervisor and Occupation. If not employed, please type N/A):
Previous Employer (Include Address, Immediate Supervisors, Occupation. Please type N/A if no previous employer):
Have you ever been forced to resign or dismissed from any position?:		Yes No
Please explain if you answered yes:
Experience
Have you ever been a member of a fire department, rescue squad, or similar organization?:		Yes No
Name and Address of Organization. If none, please type N/A:
Dates of service. Please type N/A if not applicable:
Reason for leaving. Please type N/A if not applicable:
Please list any certifications you may hold:
Medical History
Have you ever had an operation or been seriously injured?:		Yes No
Explain if you answered yes:
Do you have any medical history we need to be aware of:		Yes No
Please explain if you answered yes to previous question:
Do you wear glasses or contacts:		Yes No
Any use of a hearing device:		Yes No
References
Please list three people who are not related to you by blood or marriage who are familiar with your education or work experience (Name, Complete Address, Telephone Number):
1st Reference:
2nd Reference:
3rd Reference:
Additional
In a brief paragraph, state why you wish to join this department, what the department can gain from your membership and what you expect to gain from membership :
If you were referred by a current Blacksburg Volunteer Fire Department member, who can we thank for the reference:
(This statement must be signed. Please read the following statement carefully before signing.) :
Certification and Agreement: I hereby certify that the facts set forth in the above Volunteer Membership Applications are true and complete to the best of my knowledge.:
Name of Applicant (This Will serve as a Digital Signature):
Date and Time:		06/02/2026 0232
Parent of Guardian Name (If Under 18):
CRIMINAL HISTORY BACKGROUND AND MUST BE PROVIDED BY CHEROKEE COUNTY, SOUTH CAROLINA DURING ANY APPLICATION PROCESS PRIOR TO APPROVAL AND ACCEPTANCE OF THIS APPLICATION.: