Stratfield VFD Membership Application

You will be contacted by phone for an interview.

Application Type

Active     Social

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:

How did you hear about us?

Referred by Someone  Cablevision Ad    CT Post    Fairfield Citizen    Billboard

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.