Form Center

2. Please fill out the following form completely. Once we have received your completed form, a volunteer officer will call you within 72 hours to schedule a tour and visit to the station.
4. First Name*
5. Last Name*
7. Address*
9. City*
11. State*
13. Zip Code*
15. Home Telephone Number*
16. Cell Phone Number*
18. Email Address*
20. How did you hear about volunteering with us?*

    1. E-mail
    2. Phone
    3. Website
    4. Facebook
    5. Flyer
    6. Poster
    7. Direct Mail
    8. Advertisement
    9. Visited Station
    10. Other
22. Are you 16 years of age or older?*

    1. Yes
    2. No
24. Do you have a valid Virginia Driver's License and a good driving record?*

    1. Yes
    2. No
26. Do you have a criminal history? *

    1. Yes
    2. No
28. If so, please explain
30. Please tell us why you are interested in volunteering with Roanoke County Fire & Rescue Department?
32. Are you interested/available to volunteer during:*

    1. Evenings
    2. Weekends
    3. Holidays
34. Indicate which Roanoke County fire and rescue station is closest to your home:*

    1. Back Creek
    2. Bent Mountain
    3. Cave Spring
    4. Catawba
    5. Fort Lewis
    6. Hollins
    7. Masons Cove
    8. Mount Pleasant
    9. Read Mountain
    10. Vinton
36. What volunteer job are you interested in?*

    1. Firefighter
    2. Emergency Medical Technician
    3. Emergency Vehicle Driver
38. Are you available to volunteer at least one 4-hour shift per week?*

    1. Yes
    2. No
40. Are you able to commit to serving with Roanoke County Fire & Rescue for at least a two-year period?*

    1. Yes
    2. No
Leave This Blank:


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

    This field is not part of the form submission.

44. Submit

* indicates a required field