Application for New Membership

Application for New Membership

Fill out this form to apply for membership in the Wilton Fire District/Wilton Fire Department.
Applicant Information

Please provide your personal details.
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
How long have you lived at your current address?
Education (Schools attended, degrees, years, etc.)
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Are you at least 18 years of age?
If you are under the age of 18 but at least 16 years old, you may continue with this application. Please provide contact information for a parent / legal guardian below.
Have you ever been convicted or pled guilty to a felony, misdemeanor, insurance fraud, arson, or a reduction of one of these offenses?
If yes, provide a brief description.
Have you ever been a member of this company or any other Emergency Services organization? (Fire, Rescue, EMS, or Police)
If yes, please describe your position(s), and the number of years involved.
Fire, Rescue, EMS, or Police Reference (please provide name, phone number and email address for each reference)
Have you ever been a member of the United States Armed Forces?
If yes, please include branch and dates of service.
If yes, did you receive an honorable discharge?
If not honorable, please provide a brief description of the circumstances.
Availability for Fire Department Activities

Indicate your availability for meetings, drills, and emergency calls.
Weekdays Availability
Weekends Availability
Employment Information

Tell us about your current employment.
Are you currently employed?
If yes, may we contact your employer as a reference?
If yes, please provide the company name, and supervisor/manager phone number and email address.
Fire Department References

List any current or prior members of the fire department who would provide you with a reference
Please list any references from members of the Wilton Fire Department (if no longer active, please provide current contact information)
Personal References

List three personal references (not family or members of this organization) who have known you at least three years.
Reference 1 Name
Reference 1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference 1 Email
Reference 1 Relationship
Reference 2 Name
Reference 2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2 Email
Reference 2 Relationship
Reference 3 Name
Reference 3 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference 3 Email
Reference 3 Relationship
By signing below, I affirm that all statements made in this application are true and complete to the best of my knowledge. I understand that any false, misleading, or omitted information may result in the rejection of my application or, if discovered after acceptance, termination of my membership. I further acknowledge that certain positions within the Fire District, including firefighter roles, may require a background check and medical examination (at the Fire District’s expense) as part of the membership evaluation process.
Signature of Applicant
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Application for New Membership

Applicant Information

Availability for Fire Department Activities

Employment Information

Fire Department References

Personal References