Trumbull Volunteer Fire Service

Trumbull Volunteer Fire Service

Membership Application
Applicants for membership with the Trumbull Volunteer Fire Services must read and complete these forms in their entirety. All information you report on the following forms will be kept strictly confidential and will not be released to any other agencies without your written consent. We do not discriminate on the basis of race, national origin, age, disability, sex, gender identity, religion, or sexual orientation. If you require any assistance or accommodation in filling out the application, please contact a representative of the department you are applying to using the contact information listed. Leave a message with your name and phone number. The application process includes a background check, interview, medical examination, and drug testing. Qualification for membership is determined by the individual departments. Please ensure the following forms are completed in their entirety and the forms are signed, as required. The application will be submitted to the respective department to which you applied.
Please select what fire district you live in:*
Please use the table below to help locate which fire district you live in. Once you have located the correct one, please change your selection above. You will NOT be able to continue without selecting a valid fire district.
Full Legal Name:*
First, Middle & Last name
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Last Place of Residence

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemalePrefer not to say
Cell Phone Number*
Home Phone Number

Employment History
Any U.S. Military Service?*

NoYes
What was you rank at discharge?
Are you currently working?*

NoYesStudent
Who is your current Employer
Job Title
When did you start working

MonthDayYear
Date
Current Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have any prior employment?*

NoYes
Who is your prior employer?
Job Title:
Dates that you were employed?
Prior Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Any additional prior employment information list here.

Education and Training
What High School did you attend?
Graduation Date?

MonthDayYear
Date
Any Vocational Schools, Technical Institutes or Colleges?*

NoYes
Name of School?
What is/was your major/minor?
List any other training or certifications.
Do you have any Firefighting Experience?*

NoYes
List your experience and certifications here.
Certification Upload

Click Here to Upload your Certification(s)
(Optional) Cancelof

Emergency Contact Information
Primary Emergency Contact Name:*
Primary Emergency Contact Relationship:
Primary Emergency Contact Phone Number*
Secondary Emergency Contact Name:
Secondary Emergency Contact Relationship:
Second Emergency Contact Phone Number:

Motor Vehicle Information
Drivers License or ID Card*
DL or ID Number, State, Class
Upload a Copy of your ID (If no license, upload a blank photo)*
Personal Vehicle:
Year, Make, Model
Have you ever received a traffic summons?*

NoYes
What was the summons for?

Physical Requirements

Physical requirements disclosure
For firefighting duties, you must have the strength and ability to do prolonged manual and mechanical work under adverse conditions. Members engage directly in firefighting and rescue activities to protect and safeguard lives and property. The work involves an element of personal danger.

Members assist in the maintenance and repair of fire stations and equipment, mopping floors and cleaning debris, cleaning and minor repairs to firefighting equipment, and performing a wide variety of routing tasks associated with the maintenance of the stations and grounds. Members will also receive training in the use of various tools and equipment, handling hose lines in firefighting, climbing ladders, making openings in burning buildings for ventilation and entrance, preventing the spread of fire, wearing breathing apparatus while performing firefighting duties, performing salvage operations such as covering furniture with tarps, driving and operating fire trucks, and participating in regular firefighting drills.
Are you able and willing to perform the described physical requirements?*

NoYes

IMPORTANT, MUST READ!!!
References, Resume, & Other Information
The applicant is responsible for collecting (3) letters of reference which can be submitted prior to or at time of interview. The letters of reference shall be:- Three (3) persons not related to you, who have known you for a substantial period, preferably more than five (5) years- References must be at least twenty-one (21) years of age. - The letters of reference shall contain contact information for each individual. The fire department reserves the right to contact any individual who submits a letter of reference on your behalf. Some departments may ask for additional information such as copies of our birth certificate and background release forms.

The applicant is also responsible for providing a copy of their resume and drivers license. Those documents must be attached to this form prior to submission.

Verification Statement & Authorization for Release of Information
I hereby certify the information in this application to be true and accurate to the best of my knowledge and understanding. If any falsehoods are found on this application, it is hereby stated to be immediate grounds for complete dismissal from the application process, or termination from membership after acceptance. I understand that firefighting requires the strength and ability to do prolonged manual and mechanical work under adverse conditions. Members engage directly in firefighting and rescue activities to protect and safeguard lives and property. This work can involve an element of personal danger. Members assist in the maintenance and repair of fire stations and equipment, receive training in the use of various tools and equipment, handle hose lines in firefighting, climb ladders, make openings in burning buildings for ventilation and entrance, prevent the spread of fire, wear breathing apparatus while performing firefighting duties, perform salvage operations such as covering furniture with tarps, mopping floors, and cleaning debris, drive and operate fire apparatus, clean, maintain, and make minor repair to firefighting equipment, participate in regular firefighting drills, perform a wide variety of routine tasks in connection with the maintenance of fire stations and grounds. I hereby authorize the Fire Department to conduct a background investigation relating to my membership and temporary appointment to the Fire Department as a firefighter.

Specifically, I hereby authorize the release of any of the following data or records to the Long Hill Fire Department:

-Employment Information

-Educational Information

-Military History

-Police or Criminal Records

-DMV Driver’s Record

-Health Information
I hereby certify the information in this application to be true and accurate to the best of my knowledge and understanding. If any falsehoods are found on this application, it is hereby stated to be immediate grounds for complete dismissal from the application process, or termination from membership after acceptance.I understand that firefighting requires the strength and ability to do prolonged manual and mechanical work under adverse conditions. Members engage directly in firefighting and rescue activities to protect and safeguard lives and property. This work can involve an element of personal danger. Members assist in the maintenance and repair of fire stations and equipment, receive training in the use of various tools and equipment, handle hose lines in firefighting, climb ladders, make openings in burning buildings for ventilation and entrance, prevent the spread of fire, wear breathing apparatus while performing firefighting duties, perform salvage operations such as covering furniture with tarps, mopping floors, and cleaning debris, drive and operate fire apparatus, clean, maintain, and make minor repair to firefighting equipment, participate in regular firefighting drills, perform a wide variety of routine tasks in connection with the maintenance of fire stations and grounds. I hereby authorize the Fire Department to conduct a background investigation relating to my membership and temporary appointment to the Fire Department as a firefighter.

Specifically, I hereby authorize the release of any of the following data or records to the Trumbull Center Fire Department:

-Employment Information

-Educational Information

-Military History

-Police or Criminal Records

-DMV Driver’s Record

-Health Information
I hereby certify the information in this application to be true and accurate to the best of my knowledge and understanding. If any falsehoods are found on this application, it is hereby stated to be immediate grounds for complete dismissal from the application process, or termination from membership after acceptance.I understand that firefighting requires the strength and ability to do prolonged manual and mechanical work under adverse conditions. Members engage directly in firefighting and rescue activities to protect and safeguard lives and property. This work can involve an element of personal danger. Members assist in the maintenance and repair of fire stations and equipment, receive training in the use of various tools and equipment, handle hose lines in firefighting, climb ladders, make openings in burning buildings for ventilation and entrance, prevent the spread of fire, wear breathing apparatus while performing firefighting duties, perform salvage operations such as covering furniture with tarps, mopping floors, and cleaning debris, drive and operate fire apparatus, clean, maintain, and make minor repair to firefighting equipment, participate in regular firefighting drills, perform a wide variety of routine tasks in connection with the maintenance of fire stations and grounds. I hereby authorize the Fire Department to conduct a background investigation relating to my membership and temporary appointment to the Fire Department as a firefighter.

Specifically, I hereby authorize the release of any of the following data or records to the Nichols Fire Department:

-Employment Information

-Educational Information

-Military History

-Police or Criminal Records

-DMV Driver’s Record

-Health Information
Live-In Disclosure:

I hereby certify the information in this application to be true and accurate to the best of my knowledge and understanding. If any falsehoods are found on this application, it is hereby stated to be immediate grounds for complete dismissal from the application process, or termination from membership after acceptance.I understand that firefighting requires the strength and ability to do prolonged manual and mechanical work under adverse conditions. Members engage directly in firefighting and rescue activities to protect and safeguard lives and property. This work can involve an element of personal danger. Members assist in the maintenance and repair of fire stations and equipment, receive training in the use of various tools and equipment, handle hose lines in firefighting, climb ladders, make openings in burning buildings for ventilation and entrance, prevent the spread of fire, wear breathing apparatus while performing firefighting duties, perform salvage operations such as covering furniture with tarps, mopping floors, and cleaning debris, drive and operate fire apparatus, clean, maintain, and make minor repair to firefighting equipment, participate in regular firefighting drills, perform a wide variety of routine tasks in connection with the maintenance of fire stations and grounds. I hereby authorize the Fire Department to conduct a background investigation relating to my membership and temporary appointment to the Fire Department as a firefighter.

Specifically, I hereby authorize the release of any of the following data or records to the Long Hill Fire Department or Trumbull Center Fire Department:

-Employment Information

-Educational Information

-Military History

-Police or Criminal Records

-DMV Driver’s Record

-Health Information
Are you Over the age of 18?*

NOYES
Parent's or Legal Guardian's Acknowledgement and Signature is REQUIRED if under the age of 18.

PARENT/GAURDIAN MUST ATTEND INTERVIEW IF UNDER 18:
Please type applicants full legal name:
Please Sign Here if you agree to the above Verification Statement:*

Clear
Today's Date:

MonthDayYear
Date
Parent full legal name:
Parent Please Sign Here if you agree to the above Verification Statement:*

Clear
Today's Date:

MonthDayYear
Date
Resume Upload

Click Here to Upload your Resume
(Optional) Cancelof
Should be Empty:

Trumbull Volunteer Fire Service

General Information

Employment History

Education and Training

Emergency Contact Information

Motor Vehicle Information

Physical Requirements

IMPORTANT, MUST READ!!!

References, Resume, & Other Information

Verification Statement & Authorization for Release of Information

Parent's or Legal Guardian's Acknowledgement and Signature is REQUIRED if under the age of 18.