Part Time Fire Fighter Application Form

Fire & Emergency Services

GRAVENHURST FIRE DEPARTMENT

Application Form

Volunteer/Part-time Firefighter

Please note that all applicants will be required to provide a clear police background check (vulnerable persons) AND have a medical practitioner complete a "Pre-Employment Screening" indicating you are fit to perform the duties associated with being a firefighter prior to commencing employment. The necessary forms will be provided if/when placement is offered.

PERSONAL INFORMATION

Confidential When Completed

Last Name

Given name

Initial

Address

Postal Code

Telephone

Cell Phone

Email address

Emergency Contact

Emergency Contact Telephone

What fire station is the closest to your residence? What fire station is the closest to your residence?

Station 1 (190-1 Harvie Street Gravenhurst)

Station 2 (1030 Kilworthy Road Kilworthy)

Station 3 (1622 Barkway Road Ryde)

What is the approximate distance between your residence and the closest fire station? What is the approximate distance between your residence and the closest fire station?

0 - 5 km?

6 - 10 km?

11 + km?

What hours would you be available? What hours would you be available?

Weekdays?

Weekends?

Weeknights?

Other?

VOLUNTEER ELIGIBILITY REQUIREMENTS

Are you legally entitled to work in Canada? Are you legally entitled to work in Canada?

Yes

Are you at least 18 years of age? Are you at least 18 years of age?

Yes

Do you live within the Town of Gravenhurst? Do you live within the Town of Gravenhurst?

Yes

Do you have a valid Ontario drivers license? Do you have a valid Ontario drivers license?

Yes

Are you able to understand oral and written English? Are you able to understand oral and written English?

Yes

Are you able to understand oral and written French? Are you able to understand oral and written French?

Yes

Do you speak and understand other languages? Do you speak and understand other languages?

Yes

Explain

Have you ever been convicted of a criminal offence for which you have not received a pardon? Have you ever been convicted of a criminal offence for which you have not received a pardon?

Yes

EMPLOYMENT AND VOLUNTEER EXPERIENCE

Present Employer?

Name:

Address:

Contact number:

May we contact this employer? May we contact this employer?

Yes

Please explain your position with this employer, your duties and the length of time employed:

Will your employer permit you to leave work to attend emergencies within The Town of Gravenhurst? Will your employer permit you to leave work to attend emergencies within The Town of Gravenhurst?

Yes

Previous Employer?

Name:

Address:

Contact number:

May we contact this employer? May we contact this employer?

Yes

Please explain your position with this employer, your duties and the length of time employed:

Previous Employer?

Name:

Address:

Contact number:

May we contact this employer? May we contact this employer?

Yes

Please explain your position with this employer, your duties and the length of time employed:

Do you have any volunteer experience? Do you have any volunteer experience?

Yes

Only to earn my high school credits

Do you have other volunteer experience? Do you have other volunteer experience?

Yes

RELATED SKILLS or EXPERIENCE

Previous fire fighting or emergency response experience? Previous fire fighting or emergency response experience?

Yes

Previous military or police experience? Previous military or police experience?

Yes

Other experiences that may apply to this position? Other experiences that may apply to this position?

Yes

RELATED SKILLS

Indicate skill level by choosing the appropriate number and providing an explanation:

1 - A trade, licence, recognized certificate or extensive experience

2 - Advanced skills level and/or post secondary courses or apprenticeships

3 - Familiarity acquired through personal experience, high school courses or related training

Mechanics

Pumps, valves, or fire sprinkler systems

Electrical Systems:

Electronic Systems:

Computer technology:

Breathing apparatus or scuba diving

Building construction or design:

Blueprint/floor schematic reading

Fire fighting tasks

Rescue Procedures

Athletic Skills or Sports

Languages

Occupational Health & Safety

Fundraising

Office Equipment

Typing, filing or telephone systems

Public Speaking

Teaching, facilitating or coaching

Events coordination

Radio Communication

Medical or Health Sciences

Professional Driving

Heavy Equipment Operation

OTHER LICENSES AND CERTIFICATION

First Aid First Aid

Yes

CPR CPR

Yes

Defibrillation Defibrillation

Yes

Ontario Driver's License Ontario Driver's License

Yes

Other Certifications? Licenses?

Education Background

Elementary School Name:

Highest grade/level completed:

Post Secondary education:

Major or Specialization:

Level or Degree Completed:

Post Secondary education:

Major or Specialization:

Level or Degree Completed:

Please provide an accompanying resume and copies of all licenses, diplomas or certificates

CONDITIONS OF ACCEPTANCE:

I affirm and certify that the information given on, or attached this application is true and correct.

I understand that any falsification of statements, misrepresentation, deliberate omission or concealment of information may be considered just cause for immediate dismissal.

I authorize the Gravenhurst Fire Department to contact my references, previous employers or volunteer organizations as indicated and to obtain and review my medical assessment if/when a placement is offered.

Signature of Applicant

Clear

Date of Application:

Personal information is collected under the authority of the Municipal Freedom of Information and Privacy Act and will be used for candidate selection purposes only. This application form complies with the Ontario Human Rights Code.

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