Last Name

First Name

Middle Initial

Address

City

State

Zip

Telephone

Date of Birth

Place of Birth

Email Address

Have you filed an application with the Town of Colchester before? If so when?

Do you have a valid Vermont drivers license? CDL endorsement?

Have your driving privileges ever been revoked? If yes, explain

Applicants will be required to consent to a Criminal Records Check

List current membership in other organizations:

Previous Firefighting Experience

List any special licenses or certifications you currently hold: