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Acknowledgement

Applicants must complete all sections of this application. This application should not be construed as a contract. Volunteer service with New Kent Fire-Rescue as an operational fire and/or EMS provider is at will and may be terminated at any time, with or without notice and/or cause. This application involves volunteer service only and does not create or confer any employment rights on the volunteer. The County of New Kent expressly disclaims any employment obligations whatsoever for volunteers accepted into service.
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Personal Information

Personal Information
First Name*
Middle Name
Last Name*
Date Of Birth*
Date Of Birth
Social Security Number*
Address1*
Address2
City*
State*
Zip Code*
E-mail Address*
Best Contact Number*
New Kent Resident?*
1. Yes
1. No
Emergency Contact Information
First Name*
Last Name*
Address1*
Address2
City*
State*
Zip*
Relationship*
E-mail Address*
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Background/History

Criminal History
Have you ever been convicted of any crime? This includes misdemeanors, traffic offenses, and/or felonies.*
Affirmative answers do not necessarily disqualify the applicant from consideration for volunteer service
1. Yes
1. No
If you answered yes, please explain in detail.
Do you consent to a search of conviction information from your Local, State, and National Criminal History Files?*
1. Yes
1. No
Driving History
Do you currently hold a valid Driver's License?*
1. Yes
1. No
Drivers License State
Driver's License Number:
Drivers License Expiration:
Drivers License Expiration:
Do you consent to the release and review of your Driver's Transcript and/or records, now and on a periodic basis during service for repeated or significant traffic violations?*
1. Yes
2. No
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Qualifications, Skills, & Training

Education Background

High School Attended*
Indicate if you graduated or the highest grade level achieved
Did you Graduate?*
1. Yes
2. No
College Attended
Indicate degree obtained or semester hours accumulated
Any other schools that you have attended
Please indicate degree obtained
Honors, Awards, etc...
Professional or trade certifications/ licenses
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Employment History

Employment History
Please list your employment history for the last 10 years starting with the most recent. Do not include volunteer experiences as that will be obtained in another section.
Employer/Company Name:*
Immediate Supervisor Name:*
Address:*
Supervisor Phone Number:*
Job Title:*
Date Hired*
Date Hired
Date Left:*
Date Left:
If still employed, use today's date as end date and put "still employed" in the reason for leaving.
Job Description/ Duties:*
Reason for Leaving:*
Hours worked per week:*
May we contact?*
Employer/Company Name:
Immediate Supervisor Name:
Address:
Supervisor Phone Number:
Job Title:
Date Hired
Date Hired
Date Left:
Date Left:
Job Description/ Duties:
Reason for Leaving:
Hours worked per week:
May we contact?
Employer/Company Name:
Immediate Supervisor Name:
Address:
Supervisor Phone Number:
Job Title:
Date Hired
Date Hired
Date Left:
Date Left:
Job Description/ Duties:
Reason for Leaving:
Hours worked per week:
May we contact?
Employer/Company Name:
Immediate Supervisor Name:
Address:
Supervisor Phone Number:
Job Title:
Date Hired
Date Hired
Date Left:
Date Left:
Job Description/ Duties:
Reason for Leaving:
Hours worked per week:
May we contact?
Employer/Company Name:
Immediate Supervisor Name:
Address:
Supervisor Phone Number:
Job Title:
Date Hired
Date Hired
Date Left:
Date Left:
Job Description/ Duties:
Reason for Leaving:
Hours worked per week:
May we contact?
Employer/Company Name:
Immediate Supervisor Name:
Address:
Supervisor Phone Number:
Job Title:
Date Hired
Date Hired
Date Left:
Date Left:
Job Description/ Duties:
Reason for Leaving:
Hours worked per week:
May we contact?
Employer/Company Name:
Immediate Supervisor Name:
Address:
Supervisor Phone Number:
Job Title:
Date Hired
Date Hired
Date Left:
Date Left:
Job Description/ Duties:
Reason for Leaving:
Hours worked per week:
May we contact?
Employment Gaps*
Explain any gaps in employment history, or indicate none if not applicable.
Have you ever been terminated, asked to resign, or resigned to avoid discharge from a job?*
1. Yes
1. No
If yes, please explain:
Affirmative answers do not necessarily disqualify the applicant for consideration for volunteer service.
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Volunteer Experience

Volunteer Experiences
Please list any previous volunteer experiences over the last 10 years.
Organization:
Immediate Supervisor Name:
Address:
Supervisor Phone Number:
Date Started:
Date Started:
Date Left:
Date Left:
Average Contributing Hours Per Month:
Roles/Responsibilities:
Reason for Leaving:
May we contact?
Organization:
Immediate Supervisor Name:
Address:
Supervisor Phone Number:
Date Started:
Date Started:
Date Left:
Date Left:
Average Contributing Hours Per Month:
Roles/Responsibilities:
Reason for Leaving:
May we contact?
Organization:
Immediate Supervisor Name:
Address:
Supervisor Phone Number:
Date Started:
Date Started:
Date Left:
Date Left:
Average Contributing Hours Per Month:
Roles/Responsibilities:
Reason for Leaving:
May we contact?
Organization:
Immediate Supervisor Name:
Address:
Supervisor Phone Number:
Date Started:
Date Started:
Date Left:
Date Left:
Average Contributing Hours Per Month:
Roles/Responsibilities:
Reason for Leaving:
May we contact?
Organization:
Immediate Supervisor Name:
Address:
Supervisor Phone Number:
Date Started:
Date Started:
Date Left:
Date Left:
Average Contributing Hours Per Month:
Roles/Responsibilities:
Reason for Leaving:
May we contact?
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References

Character References:
Please list 3 references that have known you for a minimum of 2 years. Do not include relatives.
First Name*
Last Name*
Relation:*
Contact Phone Number:*
E-mail Address:*
First Name*
Last Name*
Relation:*
Contact Phone Number:*
E-mail Address:*
First Name*
Last Name*
Relation:*
Contact Phone Number:*
E-mail Address:*

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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NKFR Volunteer Application

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Acknowledgement

Personal Information

Background/History

Qualifications, Skills, & Training

Education Background

Employment History

Volunteer Experience

References

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