Greenwich Volunteer Firefighter Application
Personal Information
Name
*
Prefix
First Name
Middle Name
Last Name
Suffix
Are you over the age of 18?
*
Yes
No
Phone Number
*
-
Area Code
Phone Number
Secondary Phone
-
Area Code
Phone Number
Email
*
example@example.com
Home Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Greenwich Work Address (if residing elsewhere)
Business Name
Street Address
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Emergency Contact
*
First Name
Last Name
Relationship
Emergency Contact Phone Number
-
Area Code
Phone Number
What made you interested in volunteering with the Greenwich Fire Department?
Company Preference
*
Amogerone Co 1
Cos Cob Fire Co 2
Cos Cob Fire Patrol
Byram Co 3
Glenville Co 4
Sound Beach Co 5
Round Hill Co 6
Banksville Co 7
Undecided/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
Expiration
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
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
Please select your general availability for the given days and times
*
Monday - Days
Monday - Nights
Tuesday - Days
Tuesday - Nights
Wednesday - Days
Wednesday - Nights
Thursday - Days
Thursday - Nights
Friday - Days
Friday - Nights
Saturday - Days
Saturday - Nights
Sunday - Days
Sunday - 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
-
Month
-
Day
Year
Date
Signature
Submit
Should be Empty: