Stratfield VFD Membership Application

You will be contacted by phone for an interview.

Personal Information

First Name:     Middle Initial:     Last Name:

Address:     City:     State:     Zip:

Length at Current Address:

Previous Address (If less than 10 years at current):     City:     State:     Zip:

Length at Previous Address:

Home Phone:     Cell Phone:     Other Phone:

DOB:     Social Security #:     Email Address:

Drivers License #:     State:     License Type:

Education

Name of High School:     City:     State:  :   Year Graduated:

Name of College:     City:     State:

Major:     Year Graduated:     Military Experience:

Further Education:

Employment

Name of Employer:     Phone:     Length of Employment:

Address:     City:     State:     Zip:

Previous Employer:     Phone:     Length of Employment:

Address:     City:     State:     Zip:

Experience

Please list any firefighting experience: Please list any first aid / emergency medical experience:

Please list any special skills:

History

Have you ever been convicted of a misdemeanor or felony? (If yes, please explain): Have you ever had any traffic violations in the last 3 years? (If yes, please explain):

References

Name:     Phone:     Relationship:

Name:     Phone:     Relationship:

If a current or previous member referred you, please list: Name:     Phone:     Relationship:

I, the undersigned, do hereby apply for membership with the Stratfield Volunteer Fire Department, Inc. I give my consent for the Stratfield Volunteer Fire Department, Inc. to conduct an investigation into my past, including, but not limited to: local and state police criminal records, Department of Motor Vehicles history, contacting of current and previous employers, and contact of references. I understand that investigation of the previously mentioned history could result in my not being accepted for membership at the discretion of the Stratfield Volunteer Fire Department, Inc. I further understand that making false statements or willfully withholding information on this application will be grounds for rejection of the application and/or immediate dismissal from the Stratfield Volunteer Fire Department, Inc. As a member I understand that I must abide by all rules and regulations of the Stratfield Volunteer Fire Department, Inc., the Fairfield Fire Department and all federal, state and municipal laws and regulations. I agree to these terms and hereby certify that all statements made on this application are to the best of my ability, complete and true. I understand that the Stratfield Volunteer Fire Department, Inc. does not discriminate based on sex, race, ethnicity, sexual orientation, national origin, mental or physical ability.