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Public Safety Volunteer Application

  1. Making false statements on this application will disqualify this application
    and you from applying within our agency for a period up to one year!

    Please Note: Virginia Office of EMS (OEMS) requires all applicants after January 1, 2013 to be fingerprinted for their background check

  2. Do you have a valid "Virginia" driver’s license?*
  3. Have you ever been convicted of any law violation including a misdemeanor or felony?*
  4. Have you ever been convicted of any traffic violation?*
  5. Are you under the age of 18?*
  6. BY TYPING or SIGNING YOUR NAME, YOU ARE CERTIFYING THAT YOU HAVE READ AND AGREE WITH THE FOLLOWING STATEMENT IN ITS ENTIRETY.*
    I agree that my typed name on this document is the legally binding equivalent to my handwritten signature, and that the information provided is true and accurate to the best of my knowledge and is a complete record. I authorize the Department of Public Safety to investigate my criminal and motor vehicle operation background to verify the information is correct.
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  8. This field is not part of the form submission.