Turn of River Fire Department Membership Application

Turn of River Fire Department Membership Application

This is an online version of our membership application. We expect that it will take approximately 20 minutes to complete. Required questions are noted with an asterisk (*), others are optional.
Turn of River Fire Department

268 Turn of River Road
Stamford, CT 06905 Fax: (203) 322-8367 Phone: (203) 322-0943
To whom it may concern: Attached is my application for membership with the Turn of River Fire Department TRFD I have given my full name, address, and other pertinent information as requested. I understand that this application must be completed in its entirety in order to receive consideration for membership. I certify that I have fully completed this application, and that I have given all information herein without omission or falsification. I further attest that no information has been withheld about me or my background which may cause concern to you in any way. I certify that I am at least seventeen 17 years of age, a citizen or legal resident of the United States, a resident of Stamford or employed in Stamford at least 40 hours per week, and have a valid social security number. By signing this letter, I consent to the investigation of all facts and circumstances given in the attached application for membership to TRFD. I also consent to the interview of any references provided herein, and to any background investigation needed by any police organization or TRFD. I understand that I am subject to an agility test, a physical examination, and drug screening. I fully understand that should any information herein be investigated and found to be false, that I will be subject to immediate dismissal from the Turn of River Fire Department without recourse.
Applicants Signature*
Date of Application*

MonthDayYear
Date
TURN OF RIVER FIRE DEPARTMENT

Application for Membership
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Current Address*
MaleFemale
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Alt Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Military Service
YesNo
If yes, branch:
Date of Military Service: From

MonthDayYear
Date
Date of Military Service: To

MonthDayYear
Date
Type of Discharge
Current Employment
Present Employer
Supervisors Name
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Address
Position Held
Length of Employment
Straight DaysStraight NightsStraight EveningsOther
8 Hr10 Hr12 Hr24 Hr
Application Certification

Candidate proposed by the following Turn of River firefighters (must hold rank of First Grade):
Signature 1
PRINT last name 1
Signature 2
PRINT last name 2
Signature 3
PRINT last name 3
ActiveAssociateHonoraryProbationaryJunior
Fee Received $
FD Secretary
Background Information
YesNo
If your answer is Yes explain in the space provided giving the dates and nature of the offenses the name and location of the court and the disposition of the case
Education
High School Name
High School State
High School Start Date

MonthDayYear
Date
High School End Date

MonthDayYear
Date
High School Graduate?
College 1 Name
College 1 State
College 1 Start Date

MonthDayYear
Date
College 1 End Date

MonthDayYear
Date
College 1 Graduate?
College 2 Name
College 2 State
College 2 Start Date

MonthDayYear
Date
College 2 End Date

MonthDayYear
Date
College 2 Graduate?
If you did not graduate from high school, did you obtain a GED?
If yes, in what state did you receive your GED?
Fire Fighting Experience and Training
Have you previously been a member of one or more Fire Departments?
Fire Department 1 Name
Fire Department 1 Address
Fire Department 1 Start Date

MonthDayYear
Date
Fire Department 1 End Date

MonthDayYear
Date
Fire Department 2 Name
Fire Department 2 Address
Fire Department 2 Start Date

MonthDayYear
Date
Fire Department 2 End Date

MonthDayYear
Date
Have you attended any firefighting schools previously?
If "Yes", include copies of any certifications you have received with this application.
References
Have you applied for membership with the Turn of River Fire Department previously?*
Are you currently a member of another fire department?*
List any members of the Turn of River Fire Department with whom you are acquainted
List 3 references other than relatives and any named above (name/phone/relationship) 1 per line.
Emergency Contact Information
Emergency Contact Name*
Emergency Contact Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Relationship*
Why do you want to be a Firefighter?*
Statement of Veracity
Read your answers carefully and read the statement below before signing:

I represent and warrant that the information I have given is complete and true to the best of my knowledge and belief. I further acknowledge that I have read and understood the questions regarding criminal records and my background, and that I have answered these questions completely and truthfully. I understand that failure to answer all questions completely and truthfully will subject me to dismissal from the Turn of River Fire Department.
Applicants Signature*
Date*

MonthDayYear
Date
If applicant is under 18 years of age:
Guardian Signature
Print Name
Date

MonthDayYear
Date
Should be Empty: