Volunteer Membership Application
Please complete the below form in its entirety to begin the process of volunteering with our agency.

After completing the form, you should expect to hear from the Secretary of our Board of Directors via email who will detail the interview process, how to schedule an interview, and other important requirements for completing the volunteer application process.

If you have any questions or wish to amend your application after submitting, please email secretary@pevrs.org. Thank you for your interest!
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First & Last Name *
Preferred Name *
Date of Birth *
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Current Occupation *
Permanent Address *
Mailing Address (if different from permanent address)
Cell Phone *
Email Address *
Do you believe you can commit to the required 24-hours of quarterly service? *
All volunteer members of the Prince Edward Volunteer Rescue Squad MUST commit to a minimum of 24 hours of service per quarter (every three months).
Do you currently have an in-date CPR certification? *
Are you currently certified as an EMS provider in Virginia?
Clear selection
If so, what level of EMS certification do you have?
Clear selection
Are you currently certified with any level(s) of EVOC (Emergency Vehicle Operation Course) certification? *
Have you been previously affiliated with another fire or EMS agency? If so, please provide the agency name and phone number.
What is your highest level of education? *
Please provide three personal/professional references. Include their name, phone number, and relationship to you. *
Have you ever applied for volunteer membership with Prince Edward Volunteer Rescue Squad? *
If yes, when?
Have you ever been convicted of any criminal offense?
 *
If yes, give offense(s) and dates.
Please list any additional training or certifications you'd like us to know about.
Minimum Age Requirement: I understand that the minimum age to work or volunteer at the Prince Edward Volunteer Rescue Squad is 18 years of age. *
Signature Declaration: I declare that the above information is true and complete to the best of my knowledge. I authorize the Executive Committee to review criminal background checks and motor vehicle reports for use during the application process. I understand that if any part of this application is found to be false, my application will be rejected and I will not be considered again for membership to this organization. I also agree, upon acceptance into the membership, to abide by the Constitution and Bylaws and Standing Operating Procedures and to obtain all training needed to remain a member in good standing *
Signature of Applicant *
Please type your full name denoting that you understand the above statements, and to confirm that all of the information you provided above is true to the best of your knowledge.
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