Thank you for showing interest in joining our department. Use the form below to apply for membership to the Hollywood Volunteer Fire Department. After completing this form, a representative of the membership committee will contact you. In the meantime, feel free to come down and visit the station. Hollywood Volunteer Fire Department has four (4) Membership Types: Cadet – A Cadet is someone 14 and 16 years of age who attends drills on Thursdays to learn about fire apparatus, their equipment and some basic fire ground skills. Cadets also participate in fire prevention activities and fund raising events. Cadets are not able to respond to emergency incidents on fire apparatus. Junior – A Junior member is someone 16-18 years old who attends drills and meetings while completing a Pre-Basic program to learn about fire apparatus, their equipment and some basic fire ground skills. Junior members may not respond to emergency incidents on fire apparatus until completing the Pre-Basic program and are still limited in the activities on scene they can participate it. Active – An Active member is someone at least 18 years and older who attends drills and meetings while completing a Pre-Basic program to learn about fire apparatus, their equipment and some basic fire ground skills. Active members may not respond to emergency incidents on fire apparatus until completing the Pre-Basic program and are still limited in the activities on scene they can participate it. Associate - Associate membership in this company shall be at least 18 years of age who profess a desire and who intend to actively support the fund raising activities of this company. Associate membership dues are payable on or before the first of January each year, said dues being ($10.00) ten dollars per year. Duties of the associate members are to actively assist the company in all fund raising activities.

Indicates Required Field

Membership Type:		Select Below Cadet Junior Active Associate
Personal Information
Last Name:
First Name:
Middle Name:
Physical Address:
City:
State:
Zipcode:
Date of Birth:
Social Security Number:
Mailing Address (if different from Physical):
Home Phone:
Cell Phone:
Work Phone:
Email Address:
Do you have a valid Driver's License? :		Select Below Yes No
State and Class of Driver's License:
Driver's License Number:
Work and School Information
Occupation:
Place of Employment:
Are you still in school?:		Select Below Yes No
Name of School (if applicable):
Medical Information
Do you have any physical/medical conditions which may prohibit you from performing any firefighting duties?:		Select Below Yes No
If yes, please explain:
Emergency Contact Name / Relationship:
Emergency Contact Phone Number:
Physician:
Physician Phone Number:
Firefighting Experience
Do you have any firefighting experience?:		Select Below Yes No
If yes, please provide where you have experience:
Training Obtained (if applicable):
Certifications (if applicable):
Criminal information
Have you ever been convicted of a crime other than a misdemeanor?:		Select Below Yes No
If yes, please explain:
References
Provide three (3) references, not related to you. Please provide a name, address and phone number for all three.:
This application will be held for uo to thirty (30) days to allow time to process and a background check.
I certify that all statements are true. I understand that any false statements made will be grounds for rejection or dismissal. I agree to abide by the By-Laws and rules of the Hollywood Volunteer Fire Department, Inc.
By typing my name I am certifying that all the information is honest and correct.
Signature of Applicant:
Signature of Parent or Guardian (If applicant is under 18):
Date of submission :		04/26/2024 0954
Thank you for your interest in becoming a member of the Hollywood Volunteer Fire Department. The Membership Committee will review your application and a representative will contact you after your application has been reviewed. For more information, please contact membership@hvfd7.com