Use the form below to apply for membership to the Bay District 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 stations.

The Bay District Volunteer Fire Department has Three (3) Membership types:

Associate – Open to all persons 16 years and older. Associate Membership provides support to the Bay District Volunteer Fire Department by assisting with Fire Prevention, Fund Raising and Fire Ground Rehabilitation.

Junior Membership – open to all persons 16 – 17 years old. Junior Members participate in all firefighting activities (i.e. – responds to emergency incidents, participates in training, assist with fund raising and performs fire prevention activities).

Senior Membership – Senior Membership is open to all persons 18 and older. Senior Members participate in all firefighting activities (i.e. – responds to emergency incidents, participates in training, assist with fund raising and performs fire prevention activities).

*All prospective members MUST print the BDVFD Health Certificate and have it filled out by your physician and returned to Bay District Volunteer Fire Department prior to being accepted into probationary membership”

*Prospective members will be required to pay a non-refundable fee of $20.00 for the background check and key fob at the first membership meeting prior to acceptance of application (This does not apply to Junior Members; Junior Members need to have $5.00 fee for key fob for doors).

Indicates Required Field

PERSONAL
Submitted on:		05/02/2024 0101
Membership Type:		Select Below Associate Junior Senior
Name: Last, First, Middle Initial
Address: Street Address, City, State, Zip Code
E-mail Address:
How long have you lived at this address?:
Home Phone:
Cell Phone:
Sex:		Select Below Female Male
Where are you currently employed:
If you were in the Armed Forces, when were you discharged? :
Date of Birth:
Driver's License #:
Driver's License State:		Select Below Alabama - AL Alaska - AK American Samoa - AS Arizona - AZ Arkansas - AR California - CA Colorado - CO Connecticut - CT Delaware - DE District of Columbia - DC Federated States of Micronesia - FM Florida - FL Georgia - GA Guam - GU Hawaii - HI Idaho - ID Illinois - IL Indiana - IN Iowa - IA Kansas - KS Kentucky - KY Louisiana - LA Maine - ME Marshall Islands - MH Maryland - MD Massachusetts - MA Michigan - MI Minnesota - MN Mississippi - MS Missouri - MO Montana - MT Nebraska - NE Nevada - NV New Hampshire - NH New Jersey - NJ New Mexico - NM New York - NY North Carolina - NC North Dakota - ND Northern Mariana Islands - MP Ohio - OH Oklahoma - OK Oregon - OR Palau - PW Pennsylvania - PA Puerto Rico - PR Rhode Island - RI South Carolina - SC South Dakota - SD Tennessee - TN Texas - TX Utah - UT Vermont - VT Virgin Islands - VI Virginia - VA Washington - WA West Virginia - WV Wisconsin - WI Wyoming - WY
Have you ever been convicted of a traffic violation, misdemeanor, or a felony:		Select Below No Yes
If Yes, indicate the date and nature of the charge, police agency, court, and disposition:
MEDICAL HISTORY
Have you ever had an operation?:		Select Below No Yes
Have you ever been seriously injured?:		Select Below No Yes
Have you ever been refused employment for reasons of health?:		Select Below No Yes
Have you ever been forced to resign from a job or volunteer position for health reasons?:		Select Below No Yes
Have you ever fractured any bones or dislocated any joints?:		Select Below No Yes
Have you ever been refused life insurance?:		Select Below No Yes
Have you ever been diagnosed with an illness caused by your job or volunteer position?:		Select Below No Yes
Have you ever injured your back?:		Select Below No Yes
Have you ever suffered from lung problems?:		Select Below No Yes
Have you ever suffered from heart problems?:		Select Below No Yes
Have you ever suffered from swelling of the legs or ankles?:		Select Below No Yes
Have you ever suffered from fainting spells or dizziness?:		Select Below No Yes
Have you ever suffered from frequent headaches?:		Select Below No Yes
Have you ever been treated, hospitalized or on medication for mental illness?:		Select Below No Yes
Do/are you currently wearing glasses?:		Select Below No Yes
Do/are you using a hearing aid?:		Select Below No Yes
Do/are you on any medications?:		Select Below No Yes
If you answered yes to any of the above, please provide more information.:
EXPERIENCE
Have you ever filed an application Bay District Volunteer Fire Department?:		Select Below No Yes
If so, when?:
Have you ever been a member of any other fire or rescue department(s)?:		Select Below No Yes
If you have been a member of any other fire or rescue department please list department name(s) and date(s):
Have you ever been denied membership to a fire and/or rescue squad?:		Select Below No Yes
If so, please give details:
Have you ever been discharged for misconduct or unsatisfactory service or asked to resign from a fire and/or rescue department?:		Select Below No Yes
If you have been discharged, please give details:
List any firefighting and/or emergency medical certifications that are current. Please provide copies of certifications:
Please provide copies of certifications: Upload documents here. DOC, DOCX, PDF, XLS, XLSX, PPT, PPTX, TXT, JPG, JPEG, PNG		Add files...
EDUCATION
High School Attended: Include Location (City/State)
Did you graduate or receive a GED:		Select Below GED Graduate N/A
Date graduated, or received GED:
College or University: College or University, Location (City/State), Dates attended, Major or Degree awarded
REFERENCES (NOT Members of Bay District)
Reference #1: Name, Address, Phone Number
Reference #2: Name, Address, Phone Number
Reference #3: Name, Address, Phone Number
EMERGENCY CONTACT
Emergency Contact Information: Name, Relationship, Address, Phone Number, Additional Phone Number
ACKNOWLEDGEMENT
How did you hear about us?: Select ALL that apply		County Recruitment Program Email Friend Member Recruitment Flier School Guidance Counselor Social Media State Recruitment Program
Please type your signature here:
By signing my digital signature above, I signify that I have applied for the membership to the Bay District Volunteer Fire Department Inc.; that I have answered all questions truthfully and to the best of my knowledge; and that I fully understand that any intentional false statement may be grounds for dismissal from the department. Furthermore, I hereby grant to Bay District Volunteer Fire Department Inc. permission to contact my employer, references, and any other persons or agencies who may have knowledge of me, my skills and my experience as may be deemed necessary. I also understand that I will be required to undergo a mandatory physical at the applicants' expense to be considered for Operational Membership.  If you have any questions, please contact Application@bdvfd.org.