Volunteer Firefighter Application - Township of Minden Hills

Volunteer Firefighter Application

Required fields are marked with asterisks(*)

All pages of the application form must be completed in full or the applicaiton will not be considered. Resumes may be attached to accomany application forms but may not be substituted for the formal application form.

Personal Information

Last Name

First Name

Phone

Email

Residence Address

Street/911 Address

PO Box

City

Postal Code

I am a permanent resident or tenant in the Township of Minden Hills

Yes

No

Mailing Address

If different from above.

Street/911 Address

PO Box

City

Postal Code

Education

Grade 12 (or equivalent)

College or University attended

Employment Experience

Employer Name

Position held

From

To

Employer Name

Position held

From

To

Experience

Previous/Current Firefighting

Number of Years

Volunteer or Community Work

Number of Years/Months

Additional comments on related work experience

Driving Experience

Preference will be given to those with a valid Ontario DZ licence. (DZ licence is required to pass probationary period)

G

DZ

AZ

Other

Have you had any experience in driving heavy equipment/vehicles?

Yes

No

If yes, please explain

Do you possess certification or training in any of the following areas

First Aid/CPR

Fire Suppression

knowledge of breathing apparatus - scuba diving, etc.

Rescue Procedures

Other

No Certifications

Please list any training/certifications, special skills or abilities not covered above that you feel would be beneficial to the department

Availability

What times are you available? Please check all that apply

Day Time

Evenings & Night Time

Weekends & Holidays

Are you able to attend weekly training practices with the department?

Yes

No

Is your current employer willing to allow you to attend at emergency calls during working hours?

Yes

No

I Understand and Agree:

Selected applicants may be interviewed by an interview panel that will include representatives of the Fire Department and the municipality as required.
Selected applicants will be asked to provide contact information for persons and/or organizations for the purpose of obtaining reference information.
Selected applicants may be subject to a physical examination by a licenced medical practioner, at the applicant's expense.
Selected applicants shall be required to submit a Vulnerable Sector Check and a clean Driver's Abstract, at the applicant's expense, prior to commencement of duties.
Selected applicants are subject to a 12 month probationary period and are required to successfully complete minimum training requirements before full status is given.

In accordance with the Municipal Freedom of Information and Protection of Privacy Act, the information gathered on this form is collected under the authority of the Act and will only be used for the purpose of determining eligibility for employment as a Volunteer Firefighter with the Township of Minden Hills.

Questions about this collection of personal information should be directed to the Municipal Clerk of the Township of Minden Hills, 7 Milne Street, Minden ON, K0M 2K0 705-286-1260.

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I understand and agree:

I agree

Print Name

Date of Submission