PROTECTION SERVICES

Fire Dept: Volunteer Application Form

1.	Full Name:
2.	Address:
3.	Telephone
4.	Date of Birth:
5.	Social Insurance #:
6.	Driver's License #:
	Class:
	Endorse:
7.	Do you own a car?	Yes No
8.	Who if your Employer?
9.	Employer's Address (Bus):
10.	Employer's Phone #:
11.	Do you work shift work?	Yes No
12.	Normal working hours:
13.	Are you subject to standby in your work?	Yes No
14.	Will your Employer permit your to leave for Fire Emergencies?	Yes No
15.	Are you available to attend to training sessions on Monday and Wednesday evenings from 7:00 p.m. - 9:30 p.m.?	Yes No
16.	Are you willing to have the fire alarm system installed on your phone?	Yes No
17.	Do you have any physical disabilities which may affect your performance as a firefighter?	Yes No
	If yes, please specify:
18.	Do you have any previous traning related to fire department operations?	Yes No
	If yes, please specify:
19.	Do you hold certificates in any of the following?
	St. John Ambulance First Aid	Yes No
	CPR Heart Saver	Yes No
	CPR Rescuer	Yes No
	Oxygen Administration	Yes No
20.	References:
	Name:	Phone:
	Name:	Phone:
	Name:	Phone:

	Please make sure all information is correct before submitting

Contact Information:

Gander Fire Rescue

P.O. Box 84
Gander, NF
A1V 1W5
tel -709-256-8887
fax - 709-256-4172