Membership

We are always looking for new members. Please consider joining our team of professionals.

If you are interested, please drop me an e-mail.

Thank you.

Chief Brian Koczak – chief@nmvfc.org


Membership Application

Click above to download our membership application – alternatively you may also fill out and submit our digital form below. (Adobe PDF Format)

Online Membership Application Form

I. Applicant Information
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  4. Address
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  15. If Yes:
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II. Education and Firefighting / Emergency Experience
  1. High School or Equivalency?
  4. College or Other Training after High School, including Military Service. If Military, state character of discharged as stated on DD-214
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  16. Have you ever belonged to a Fire Department or Emergency Services organization before?
  18. If Yes, give details:
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III. Current Employment
  1. Attach Additional Documents if necessary
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  3. Address
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IV. Emergency Information
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V. Legal Information**
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  2. If Yes, attach a separate page identifying date(s), jurisdiction and details:
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  6. **This information will be verified. Affirmative answers will not necessarily exclude you from membership; however, the information will be considered insofar as it relates to the position for which you have applied.
VI. Short Answer
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VI. Applicant Statement
  1. I attest that all information provided in this application and its attachments are true and correct, and I authorize the North Madison Volunteer Fire Company and/or its agents to investigate the veracity of said information. I understand that misrepresentation or omission of facts may cause for rejection of this application and/or future termination of my membership with the North Madison Volunteer Fire Company. I understand that acceptance of this application is dependent upon my successful completion of a physical examination by the Company’s designated physician, and completion of the North Madison Volunteer Fire Company Probationary Training. I also understand that members are required to attend a minimum of twelve training sessions and six monthly business meeting per year. Firefighter candidates are required to complete Connecticut Firefighter 1 within 18 months of regular membership. EMT candidates are required to complete Connecticut EMT Program within 18 months of regular membership.
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Background Inquiry Release
  1. I understand that an investigative background inquiry is to be made on myself. These reports may include information as to my character, work habits, job performance and experience, along with reasons for termination of past employment. I further understand that information will be requested from various Federal, State and other agencies which may maintain records concerning my past activities relating to my driving, criminal conduct, civil court and other experiences. I authorize, without reservation, any party or agency contacted to furnish the above information. I hereby consent to your obtaining the above information. I further understand that, to aid in the proper identification of my file or records, I am providing the following information, as well as any other information that may be required at a later date.