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GWGVFD Application Form

This form may be submitted on-line, or printed out and mailed to: GWGVFD, 801 Russell Ave., Gaithersburg, MD 20879.

To start the process of becoming a member of the Gaithersburg - Washington Grove Volunteer Fire Department please fill in each space in this form. After we receive your application you will be contacted and invited to attend a prospective-member orientation meeting. At this meeting you will need to provide:

A check or money order for $10.00, made payable to GWGVFD Fireman's Fund. This is a non-refundable application fee.
A photocopy of your high school diploma or equivalent.
A photocopy of your Maryland Motor Vehicle Record, which is obtainable from any MVA office.

Before you go fill out this application be sure that you have read the minimum requirements for, and obligations of, GWGVFD membership that are listed on our Volunteer With Us page.

Required   Indicates Required Field
Personal Information
Name: Required
Address: Required
City and State: Required
Zipcode: Required
Home Phone Area Code (###): Required
Home Phone: Required
Work Phone Area Code (###): Required
Work Phone: Required
E-mail address: Required
Are you 18 years or older?: Required Yes
No
Emergency Contact Information
Name of Contact: Required
Address of contact: Required
City and State of Contact: Required
Zipcode of contact: Required
Home Phone of contact Area Code (###): Required
Home Phone of contact: Required
Work Phone of contact Area Code (###): Required
Work Phone of contact: Required
Employment Information
Current Employer
Current Employer Name: Required
Address of current employer: Required
City and State of current employer: Required
Phone of current employer Area Code (###):
Phone of current employer:
Dates of Employment: Required
Position at current employer: Required
Former Employer
Former Employer Name: Required
Address of former employer: Required
City and State of former employer: Required
Phone of former employer Area Code (###):
Phone of former employer:
Dates of Employment with former employer: Required
Position with former employer: Required
Background Information
Drivers License Number: Required
Drivers License State: Required
Drivers License Expiration Date: Required
Has your drivers license ever been suspended or revoked?: Yes
No
If "yes" explain the circumstances, including dates::
Have you ever been convicted/sentenced/placed on probation for a criminal offense or serious traffic offense? : Yes
No
If "yes" give details, including charge, location and disposition of case::
Education and Training
High School Name: Required
Dates Attended: Required
Field of Study:
Did you graduate?: Yes
No
College Name:
Dates Attended for College:
Field of Study at College:
Did you graduate from College?: Yes
No
Other Education:
Dates Attended (other education):
Field of Study (other education):
Did you graduate (other education)?: Yes
No
List any fire-science or related courses you have taken, (e.g. EMT-B, Basic FF):
Have you ever applied to this Department before?: Yes
No
If so, when?:
Have you ever been a member of the GWGVFD?:
If been a GWGVFD member, when?:
Have you ever served in another Fire Dept?: Yes
No
If served in another Fire Dept., where and when?:
What, if any, is the highest rank you have held in any department?:
List the types, if any, of fire/rescue vehicles you have driven:
List TWO references who are not related to you
Reference One
Name of 1st Reference: Required
Address of 1st Reference: Required
City/State for 1st Reference: Required
Home Phone of 1st Reference Area Code (###): Required
Home Phone of 1st Reference: Required
Work Phone of 1st Reference Area Code (###): Required
Work Phone of 1st Reference: Required
E-mail address of 1st Reference: Required
Reference Two
Name of 2nd Reference: Required
Address of 2nd Reference: Required
City/State for 2nd Reference: Required
Home Phone of 2nd Reference Area Code (###): Required
Home Phone of 2nd Reference: Required
Work Phone of 2nd Reference Area Code (###): Required
Work Phone of 2nd Reference: Required
E-mail address of 2nd Reference: Required
Type of membership desired: Active: ride fire/rescue apparatus as Emergency Medical Technicians, Paramedics or Firefighters.
Administrative: help with non-operational duties on a regular basis.
Associate: help with non-operational duties irregularly.
Junior Fire Brigade (JFB): a program designed for teens ages 14 - 17.

By submitting this form I authorize the investigation of all statements made herein. I understand that any false statements or omissions of information requested is cause for rejection of my application. Further, I understand that my membership, (if Active), is dependent upon my successful completion of the Montgomery County Volunteer Fire/Rescue physical to be conducted by the Department's choice of physician and at their expense, in accordance with standards established by Montgomery County, and that if I do not pass the physical exam an appeal process is available through the Fire/Rescue Commission.





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Gaithersburg - Washington Grove Volunteer Fire Department
801 Russell Avenue
Gaithersburg, Maryland 20879
Emergency Dial 911
Non-Emergency Dial 311
E-mail: info@gwgvfd.org
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