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Entry Level Firefighter Application 2021

Applicants: � Must be at least 18 years old at time of application � Must have good moral character � Must be able to pass a Physical Examination as published in NFPA

Standard 1582 (details available upon request) � Must be able to obtain Internet access

Required at time of Application: � Copy of Birth Certificate � Copy of Proof of Citizenship, if different than Birth Certificate � Copy of High School Diploma or GED � Copy of Current Driver’s License (Must have Milford Address for

residency points) � Copy of Military Discharge Form DD214 reflecting an Honorable

Discharge, Active Duty Identification Card or Guard/Reserve Military Identification Card (to receive Military points).

� Copy of Valid EMT card. � Page 12 must be notarized.

Required at time of hire: � Valid Connecticut Driver’s License � Pass background check � Valid CT EMT License

City of Milford Website: Each candidate must check the Milford Fire Department's website as follows: www.ci.milford.ct.us click services, select Fire Department for all scheduling and scoring regarding the written exam, survival swim, MPAT, and oral interview.

Your identification will be your ID number provided to you from the Fire Department.

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INFORMATION FOR ENTRY LEVEL FIREFIGHTER SALARY: APPLICATION FEE: $100.00*

$1,193.06 weekly Effective 7/1/2019 Cash, Certified Check, Bank Check or

Money Order made payable to the “City of Milford” and due at the time

of submission of application. NO personal checks accepted.

(*See Filing Fee Waiver) CLOSING DATE FOR FILING APPLICATIONS: June 14, 2021

by 12:00 (noon) Applications must be hand delivered to the Milford Fire Department, Administrative Office, 72 New Haven Avenue (2nd floor) Monday through Friday, between the hours of 8:00 a.m. and 4:00 p.m. The closing date for all applications is June 14, 2021 at 12:00 noon. The application must be completed in its entirety and include a copy of the candidate’s birth certificate, high school diploma (or Connecticut State recognized equivalent certificate), EMT Card, DD214 or Military Id Card for Military Points, and driver’s license. Applicants must have internet access to check the Milford Fire Department’s web site (www.ci.milford.ct.us, click on city departments, select fire department) for all test dates and times and for all scoring results regarding the written examination, MPAT (Milford Physical Abilities Test), survival swim and oral examination. *****Note: Page 12 in the packet must be notarized before submitting application. There will not be a notary available at the Fire Department.

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QUALIFICATION REQUIREMENTS FOR ENTRY LEVEL FIREFIGHTER The Milford Fire Department is accepting applications for the purpose of establishing an eligibility list for Firefighter Recruit. This list will become effective after review and certification by the Board of Fire Commissioners and will be in effect for two (2) years from that date. HIRING PRACTICE: It is a job requirement for candidates to have and maintain their EMT status while employed as a Milford firefighter. The Milford Fire Department holds the right to select Connecticut Certified paramedics on the list over EMTs if the need within the department arises. JOB SUMMARY: The position of firefighter will be located at one of our fire stations under the general supervision of the Fire Chief. Firefighters will perform individually and/or as a member of a firefighting team and will participate in public safety activities including firefighting, rescue, emergency medical services, ventilation, forcible entry, salvage, fire prevention, and various training sessions on a regular basis to continuously update their skills and knowledge required for effective work performance. Decisions are made with guidance of a supervisor and on an individual level and have a direct effect on life and property. General job functions include, but are not limited to: 1) firefighting; 2) emergency medical services; and 3) continuous training. JOB REQUIREMENTS:

1. Good physical condition. 2. Must be at least 18 years old at time of application closure date (June

14, 2021). 3. Pass an eye examination conforming to NFPA 1582. 4. Ability to learn. 5. Ability to work safely in a hazardous atmosphere. 6. Ability to learn the use of both power and mechanical tools. 7. Ability to communicate both verbally and in writing. 8. Ability to work as a part of a team and independently. 9. Ability to adapt to various situations. 10. Ability to work in adverse weather conditions. 11. Ability to work irregular hours. 12. Willingness to conform to the department’s grooming policy. 13. Willingness to conform to the department’s Uniform Appearance

Code. 14. Must be a US Citizen.

WORKING HOURS: Forty (40) or forty-two (42) hour average workweek. Hours for the first twelve (12) months are subject to the discretion of the Chief of the Department.

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PROBATIONARY PERIOD: There will be a probationary period of at least twelve (12) months, upon completion of academy. VACATION: Ten (10) working days after the first year of service. If less than one year of service, one (1) working day for each month of service not to exceed five (5) working days. EXAMINATION: The full examination process will consist of the following:

1. Written Test (35% of total score) This exam is scheduled to be administered on June 16, 2021 beginning promptly at 6:00 p.m. The exam will be held at Platt Technical High School, 600 Orange Avenue, Milford, CT. Candidates must present his/her picture ID to obtain admittance to this exam and bring with them a No. 2 pencil.

2. Milford Physical Abilities Test (35% of total score)

This exam, which includes a Survival Swim test, will be held at Joseph A. Foran High School, 80 Foran Road, Milford, CT. The Milford Fire Department’s web site (www.ci.milford.ct.us) will advise each candidate as to the date and time of the MPAT /Swim Test. The candidate must bring proper swim attire and towel. Candidates must present his/her picture ID to obtain admittance to this exam.

3. Oral Interview(30% of total score) The Milford Fire Department’s web site will notify the candidate of the specific date and time. Candidate must present his/her picture ID at the Oral Interview.

4. Residency/Military Points Milford Residents will receive 5 points and Military applicants will receive 5 points to their final score.

5. Post Selection The Board of Fire Commissioners is the hiring authority and shall interview and make conditional offers of employment. Candidates will be considered in rank order. Selected candidates must pass a background check and pre-employment medical exam as per NFPA 1582.

NOTE: The Milford Fire Department holds the right to change or add testing dates for any of the exams as deemed necessary.

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MILFORD FIRE DEPARTMENT

Milford Physical Abilities Test

2021 The Candidates who successfully pass the written exam will move on to the MPAT. Each candidate must check the Milford Fire Department’s web site (www.ci.milford.ct.us, click on city departments, select fire department) for all scoring regarding the written examination, MPAT, and oral examination. The Milford Fire Department’s MPAT is a scored Exam. To pass the entire Firefighter MPAT, a total accumulated score of 70 points must be earned. The Survival Swim test is PASS or FAIL. If the test is Failed the candidate automatically FAILS the entire Milford Physical Abilities Test. In the event of inclement weather on the date your test is scheduled, please call (203) 878-6762 after 5:00 a.m. and the message will advise you if the event is postponed. It is the responsibility of the candidate to check the Milford Fire Department’s web site (www.ci.milford.ct.us, click on city departments, select fire department) for information pertinent to all testing. TEST EVENTS: Details of the MPAT will be posted online.

*FILING FEE WAIVER

The application fee will be waived if you are receiving Public Assistance from the State of Connecticut, or if a candidate’s income falls below the federal poverty level. A written request for a waiver must be made to the Administrative Office of the Chief of the Department, 72 New Haven Avenue, Milford, Connecticut 06460, to have the filing fee waived. You must submit a copy of your benefit card (State of Connecticut – Department of Social Services identification card) or your W-2 statement earnings for 2020. You must indicate your social security number on whichever card or method of proof you submit.

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2020 Poverty Guidelines- Effective January 17, 2020

Assistance for (1) persons $12,760.00 Assistance for (2) persons $17,240.00 Assistance for (3) persons $21,720.00 Assistance for (4) persons $26,200.00 Assistance for (5) persons $30,680.00 Assistance for (6) persons $35,160.00 Assistance for (7) persons $39,640.00 Assistance for (8) persons $44,120.00

EXTENDED TIME Candidates with a documented learning disability can apply for extended time to take the written examination. Proof of disability must be submitted with the application.

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“The City of Milford is an Equal Opportunity Employer”

MILFORD FIRE DEPARTMENT ENTRY LEVEL FIREFIGHTER EXAM

2021 I, _________________________, hereby acknowledge that I am a candidate for the position of Entry Level Firefighter for the Milford Fire Department. I further acknowledge that I have read and initialed each enumerated item below and understand the following:

1. I must participate in a competitive written examination with a

minimum passing score to be determined by the testing company. Failure to pass the written examination will disqualify the candidate. (initial) ____

2. I understand that there are MPAT/survival swim requirements and that those requirements will be available on the website. I have read and understand and signed the MPAT Waiver form. (initial) ____

3. I understand that I must hold a valid Connecticut driver’s license at

the time of hire and throughout employment. (initial) ____ 4. I understand that I must possess a valid State of Connecticut E.M.T.

certification or National Registry equivalent at time of application, which shall be maintained throughout employment. (initial) _____

5. I understand that the written exam will be held on June 16, 2021 at

6:00 p.m. at Platt Technical High School, 600 Orange Avenue, Milford, CT, and that I will not receive any further notice for such written examination. (initial) ______

6. I agree that upon employment with the Milford Fire Department I

will not smoke or use tobacco products or any illegal substance on or off duty. (initial) ______

7. I understand that a background check will be conducted and I authorize the release of any police records, Local, State or Federal, if any, to the Board of Fire Commissioners of the City of Milford, Connecticut and to the Chief of the Milford Fire Department. Any Candidate with a Felony conviction will not be considered. (initial) ______

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8. I understand that I will have to submit to and pass a medical physical

examination (NFPA 1582) and a drug test as part of a pre- employment screening. (initial) ______

9. I have read and understand the qualification requirements listed and

agree to abide by them if employed by the Milford Fire Department. (initial) ______

10. I understand that it is my responsibility as the candidate to check the

Milford Fire Department’s web site (www.ci.milford.ct.us click on city departments, select fire department) for all test dates and times and for all scoring results regarding the written examination, MPAT and oral examination. (initial) _______

11. At time of appointment, the candidate who has successfully met all criteria will be sent to the Connecticut Fire Academy’s recruit training program (14 weeks) and must successfully pass all phases of training to the satisfaction of both the State and the Milford Fire Department. Room/Board is required and provided by the Milford Fire Department. (initial) _______

12. Five (5) Military points will be given as outlined in Connecticut General

Statutes (C.G.S. Section 5-224) for the definition of Military Veteran. (initial) _______

13. Five (5) Resident points will be given to applicants who are residents of Milford at the time of application (initial) _______

I, ___________________, hereby certify that the statements made by me on this application are complete and true to the best of my knowledge and belief and are made in good faith. I understand that if I knowingly make any misstatement of fact, I am subject to disqualification or dismissal, if hired. I further understand that, as a condition of employment, I am required to pass a background check and pre-employment medical exam prior to my employment. Incomplete applications will not be processed. ________________________________ _______________________________ Signature Date

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MILFORD FIRE DEPARTMENT ENTRY LEVEL FIREFIGHTER

Milford Physical Abilities Test

2021 I, ____________________________, the undersigned hereby apply to take the Milford Fire Department MPAT/Survival Swim Test, which is part of the pre-employment testing procedures lawfully established by the Milford Board of Fire Commissioners for appointment to the Milford Fire Department. I hereby acknowledge that there will be a MPAT/survival swim as part of the testing process, and that I have decided to participate in such test and to execute this waiver of my own free will and without coercion or duress. I hereby assume all risk of injury, partial, total, temporary, permanent, or aggravation of any preexisting injury, including death and dismemberment, which I may suffer during such fitness test and hereby hold the City of Milford, its officers, employees, and agents harmless from liability for all such maladies which I may suffer during said test except as such maladies may be proximately caused by the gross negligence or willful misconduct of the City of Milford, its officers, employees and agents. This document is given in consideration for permission to participate in said fitness test. WITNESS: SIGNATURE: _______________________________ ______________________________ _______________________________ ______________________________ Print Name Date

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MILFORD FIRE DEPARTMENT ENTRY LEVEL FIREFIGHTER

MOTOR VEHICLE RECORD RELEASE AUTHORIZATION

2021 By signing below, I do hereby give my permission and authorization for the City of Milford (Milford Fire Department) to obtain a copy of my Motor Vehicle Record (through its Insurance Agent/Broker/Consultant). The information obtained will be used for company insurance, safety, loss control, job qualification, and/or compliance purposes. If hired, or if currently employed, this Release and Authorization shall remain in effect during the term of my employment. I understand that the City of Milford (Milford Fire Department) reserves the right to run subsequent Motor Vehicle Reports on an as-needed basis. ______________________________________ _______________________ (Signature) (Date) Full Name (Printed):____________________________________________________ Date of Birth: ___________________________________________________________ Driver’s License Number: ___________________________ State of Issue: ______ Current Resident Address: __________________________________________ __________________________________________

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REQUEST FOR POLICE RECORDS CHECK CT STATE DEPT OF EMERGENCY SERVICES & PUBLIC PROTECTION

NAME: ________________________________ DATE OF BIRTH: _____________ CURRENT ADDRESS: _________________________________________________ _______________________________________________________________________ PREVIOUS ADDRESS (Past 10 years): ________________________________ _______________________________________________________________________ LICENSE TYPE: _________ EXPIRATION DATE: ________ STATE: _______ DRIVER’S LICENSE NO.: ______________________________________________ My right to operate a motor vehicle has never been suspended in any State or Territory. _________ (initial) _____ My right to operate a motor vehicle is now suspended: (Indicate where and circumstances) __________________________________________ ____________________________________________________________________ ____________________________________________________________________ I understand that it is a violation of the terms of employment with the City of Milford to apply, accept or continue to occupy a position which required either the ability of the actual operation of motor vehicles, regardless of how infrequently, if my driving privilege is now or at any future time becomes suspended. I also hereby authorize and request the Milford Fire Department now and at any future time, should I become employed by the City of Milford, to verify the status of my driver’s license, as stated above, and to notify my immediate employer of any change. I understand that this authorization in no way relieves me of the obligation to promptly notify my employer of any such change. I am aware of the fact that I may not operate any vehicle of any class not authorized by my driver’s license and that it is my obligation to have my employer advised of any change in my license type. (initial). _____

DISCLOSURE List all motor vehicle arrests not subject to court ordered erasure, including town/city of occurrence: OFFENSE DATE WHERE SENTENCE/FINE _ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

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AUTHORIZATION I hereby authorize and request the Department of Emergency Services and Public Protection to release to the Chief of the Milford Fire Department for the City of Milford, Connecticut, any and all records pertaining to me that it may hold or have access to, including arrest records and incident reports, pertinent to consideration of my application for employment, on file with the employer or agency noted above. I understand that nothing will be disclosed in violation of Connecticut General Statutes, Section 54-142, or such other statutes as may apply regarding confidentiality of certain information and erasure of certain records. However, I also understand and expect that a thorough and diligent investigation will be conducted, and that information meeting the same release criteria, but obtained by the Department of Emergency Services and Public Protection from other sources, may be included, if significant to the requester’s evaluation of me. (initial) _____ I understand that the City of Milford may disqualify my application without further investigation on the basis of the extent or nature of either my voluntary or Police Department provided arrest record or driver history. I further understand that my employment application may be disqualified or my subsequent City employment status may be subject to review in the event that it becomes apparent either during the review of this application or at some future time that I have failed to disclose any information the nature of which would have reflected unfavorably upon my suitability for employment. __________________________________ ______________________________ Signature Please Print WITNESS: ________________________________ ________________________________ Subscribed and sworn to before me this ______ day of ___________________ 2021 _____________________________________ Notary Public/Commissioner of the Superior Court

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CITY OF MILFORD RELEASE FOR BACKGROUND INFORMATION

Last Name:________________________First Name:__________________________

Address:_____________________________________________________________ Street Town, State, Zip Code

Driver License #:_________________________ DL State of Issue:________

Social Security #: _________ - ______ - _________

Date of Birth: ______/______/______

Position Applied For:___________________________________________

I authorize all companies, corporations, educational institutions, former employers, law enforcement agencies, persons, Department of Motor Vehicles and military services to release information they may have about me to the person or company with which this form has been filed, or their agent, and I release them from any liability or responsibility from doing so. I also authorize the procurement of a Consumer Report and/or Investigative Consumer Report and understand that it may contain information about my background, criminal history, mode of living, character and general reputation. This authorization, in original or copy form, shall be valid for this and any further reports or updates that may be requested. Further information may be available upon written request within a reasonable period of time. ____________________________________ ______________________ Applicant’s Signature Date

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Candidate Questionnaire PLEASE PRINT

1. Name

2. Date of Birth CT Operator’s License#

3. Phone Numbers

Home/Work/Cell (Include Area Codes) 4.EmailAddress 5. Address

Street City/Town Zip

Previous Address (If less than 6 months at current address)

6. Family (Include names, addresses, phone #’s) Parents

Spouse

Siblings

7. Neighbors

(Include names, addresses, and best time to contact) (If less than 6 months, and unknown, use previous neighbors)

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DIRECTIONS TO TESTING SITES

DIRECTIONS TO PLATT TECHNICAL HIGH SCHOOL:

600 Orange Avenue Milford, CT 06460

FROM I-95-CONNECTICUT TURNPIKE TAKE EXIT 39B, WHICH PLACES YOU ON US RT. 1(BOSTON POST ROAD) GO TO FIRST SET OF STOP LIGHTS AND TURN LEFT AT BURGER KING ONTO CEDARHURST LANE. FOLLOW CEDARHURST LANE TO END. TURN RIGHT ONTO ORANGE AVE, SCHOOL IS ONE MILE UP ON LEFT. FROM RT. 15-WILBUR CROSS PARKWAY/MERRITT PARKWAY HEADING NORHT OR SOUTH, TAKE EXIT 56, AT THE END OF RAMP TURN RIGHT TOWARDS MILFORD. PROCEED APPROXIMATELY 2 1/2 MILES, PAST GOLF COURSE. TURN LEFT ON KOZLOWSKI. TURN RIGHT ON ORANGE AVE. SCHOOL ON RIGHT

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DIRECTIONS TO JOSEPH A. FORAN HIGH SCHOOL

80 Foran Road

Milford, CT 06460

From Points North (New Haven, Hartford, New London) Take I‐95 South to Exit 40 (Woodmont Road). At end of Exit, turn left onto Woodmont Road and move quickly into the far right lane. At first light, turn right onto Old Gate Lane. Continue straight for 1.1 miles (you will pass the Pilot Truck Stop, the Lowe’s Center, Fitness Edge gym). Bear to the left at the fork in the road. At the light, turn left onto Rte. 162 (New Haven Avenue). Move into the right hand lane after you turn. At the first light, turn right onto Pond Point Avenue. Continue for 1.0 mile. At the fork in the road, bear to the left (Yale Avenue). At the first light, turn left onto Edgefield Avenue. Continue approximately .1 mile. Turn left onto Foran Road. High School is at the end. Park in the visitor parking area right in front of the school. From Points South (Bridgeport, Norwalk, New York City) Take I‐95 North to Exit 40. At end of Exit, turn right onto Old Gate Lane. Continue straight for .8 mile (you will pass Lowe’s Center and Fitness Edge gym). Bear to the left at the fork in the road. At the light, turn left onto Rte. 162 (New Haven Avenue). Move into the right hand lane after you turn. At the light, turn right onto Pond Point Road. Continue for 1 mile. At the fork in the road, bear to the left (Yale Avenue). At the light, turn left onto Edgefield Avenue. Continue approximately .1 mile. Turn left onto Foran Road. High School is at the end. Park in the visitor parking area right in front of the school.