GreenwichVolunteerFirefighterApplication

Greenwich Volunteer Firefighter Application
Personal Information
Name*

PrefixFirst NameMiddle NameLast NameSuffix
YesNo
Phone Number*

Area CodePhone Number
Secondary Phone

Area CodePhone Number
Email*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Greenwich Work Address (if residing elsewhere)

Business Name

Street Address

CityState

Zip Code
Emergency Contact*

First NameLast Name
Relationship
Emergency Contact Phone Number

Area CodePhone Number
What made you interested in volunteering with the Greenwich Fire Department?
Amogerone Co 1Cos Cob Fire Co 2Cos Cob Fire PatrolByram Co 3Glenville Co 4Sound Beach Co 5Round Hill Co 6Banksville Co 7Undecided/Unknown
Have you made contact with the District Chief of your preferred Company*
Work Status
Are you legally entitled to work in the United States?*
Are you 18 years of age or older?*
Do you live or work in Greenwich?*
Identification

Please email a photo of the front and back of your License/Identification Card to stacey.collins@greenwichct.org
Do you possess a valid Driver’s License or Identification Card?*
Do you have a current CT Commercial Drivers License?*
License or Identifcation Information*

License or ID Number

Restrictions or Endorsements

ExpirationState

Issued
Do you understand that applicants will undergo a driving history and Criminal Record Check?*
Medical Questionaire
Do you believe you are free of medical conditions that may preclude your participation as a volunteer firefighter?*
Are you willing to participate in a medical check required of potential volunteer firefighters?*
Do you understand that successful applicants who obtain a firefighter certifiction are required to remain without facial hair to ensure a self-contained breathing apparatus mask will form a positive seal on the face?*
Additional Comments
Availability
Monday - DaysMonday - NightsTuesday - DaysTuesday - NightsWednesday - DaysWednesday - NightsThursday - DaysThursday - NightsFriday - DaysFriday - NightsSaturday - DaysSaturday - NightsSunday - DaysSunday - Nights
If accepted by the Fire Department, you will be required to attend regular biweekly meetings and training (approximately 6:30PM to 9:30PM). Can you meet this requirement? *
Do you understand that in order to be available for emergency response, you must be able to arrive at the fire station promptly and have abstained from alcohol and drugs for the previous 8 hours?*
Are you willing to wear an emergency pager or use an alerting app on a phone to respond to emergencies? *
Are you willing and able to participate in the occasional weekend training program?*
Skills and Experience
Previous Emergency Response/volunteer Experience - Explain:*
Do you have emergency/fire/ems related certifications – Explain:*
References
Terms and Conditions

To become a volunteer firefighter for the Town of Greenwich, I understand I must complete and PASS a Physical examination, Stress Test (to atleast 12 METS), Drug & Nicotine Test, Background Check, and driving history (if applicable)
Date

MonthDayYear
Date
Signature
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Greenwich Volunteer Firefighter Application

Personal Information

Work Status

Identification

Medical Questionaire

Availability

Skills and Experience

References

Terms and Conditions