Buckhall Volunteer Fire Department

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2015 Incidents
Month Fire EMS
Jan 77 19
Feb 74 17
Mar 73 5
Apr 66 25
May 119 16
Jun 84 23
Jul 76 9
Aug 77 10
Sep 68 14
Oct 87 7
Nov 93 6
Dec 65 8
Total 959 159

Past Incidents
Year Fire EMS
2015 959 159
2014 755 212
2013 665 292
2012 671 395
2011 375 539

Web Counters
Website Visitors
Since
November 9, 2009
401,343
Visitors Today
Jan 21, 2019
52

Membership Application

The Buckhall Volunteer Fire Department does not discriminate against qualified applicants on the basis of race, color, creed, religion, ancestry, age, gender, marital status, national origin, disability or handicap, veteran status or any other protected status.

Required   Indicates Required Field
Personal Data
Last Name: Required
First Name: Required
Middle Name: Required
Street Address: Required
City: Required
State: Required
ZIP: Required
Home Phone: Required
Daytime Telephone: Required
Mobile telephone: Required
Email Address: Required
Date of Birth: Required
Age: Required
Emergency Contact/Disclosure Contact
Emergency Contact Name: Required
Relation: Required
Contact Telephone: Required
Alternate Contact Telephone:
Certifications
Current Certification: Required None
EMT-B
EMT-E
EMT-I
EMT-P
FF-1
FF-2
Expiration:
Certification #:
Has your Certification/License ever been investigated, suspended or revoked?: Yes
No
CPR Expiration:
Driver's License #: Required
Issuing State: Required
FEMA Courses: ICS-100
ICS-200
ICS-300
ICS-400
ICS-700
ICS-800
High School
Years Completed: Required 1
2
3
4
Diploma: Required Yes
No
GED: Required Yes
No
N/A
School Name: Required
School City: Required
School State: Required
University/Vocational School
Years Completed2: 1
2
3
4
Degrees Earned:
University/School Name:
Univ City:
Univ State:
Previous Volunteer Organization
From Date:
To Date:
Still Associated: Yes
Organization Name:  :
Organization Address:
Organization City:
Organization State:
Supervison/Chief Officer:
Supervison/Chief Officer Number:
Duties:
Reason for Leaving:
Have you ever applied or been a member with Buckhall VFD: Required Yes
No
References
Ref1 Name: Required
Ref1 Phone: Required
Ref1 Email: Required
Ref1 Relation: Required
Ref2 Name: Required
Ref2 Phone: Required
Ref2 Email: Required
Ref2 Relation: Required
Ref3 Name: Required
Ref3 Phone: Required
Ref3 Email: Required
Ref3 Relation: Required
Final Steps
Typed Signature: Required
Your signature below certifies that the information contained in this application its true and correct to the best of your knowledge. You understand that any misrepresentation, falsification or material omission on this application may result in rejection of your application, disciplinary action to include expulsion, and prosecution by the Buckhall Volunteer Fire Department. I further understand and will comply with the rules and regulations as set forth in the Constitution and Bylaws of the Buckhall Volunteer Fire Department.




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Buckhall Volunteer Fire Department
7190 Yates Ford Road
Manassas, Virginia 20111

Non-Emergency:703-368-0859
Membership Phone:703-368-0859 (EXT. 505)
E-mail: Info@buckhallvfd.org
Membership Email: Membership@buckhallvfd.org
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