Volunteer Firefighter Application Form

TERRACE VOLUNTEER FIRE FIGHTERS' ASSOCIATION
APPLICATION
Date Submitted: __________________________
APPLICANT NAME: __________________________________________________________________________________

Surname First Middle
ADDRESS: __________________________________________________________________________________________
Number Street City Postal Code
PHONE: (H) __________________________________(W) __________________________ Cell ______________________
e.mail (if applicable): _________________________________________________________________
AGE: ______________________ BIRTH DATE: _________________________MARRIED/SINGLE: __________________

(Month/Day/Year)
Spouse: __________________________________________ Contact #s: _______________________________________
Emerg. Contact:_______________________________________ Relationship: __________________________________
Emerg. Contact #s: (H) _________________________(W) ________________________Cell _______________________
Life Insurance Policy Beneficiary: ______________________________________________________________________
(The Terrace Volunteer Fire Fighters' Assoc. carries life insurance on all its members)
DEPENDANTS (if any), list below:
Name: ____________________________ Relationship: _____________________ Birth Date: ________________________
A. Do you have a valid driver's license? YES NO

Class # _______________________________ Licence # __________________________ Air _________________
Restrictions (if any): ____________________________________ Expiry: __________________________________
B. Do you have any previous fire fighting experience? YES NO

If yes, describe:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
C. Do you have your employer's consent to attend fires during working hours? YES NO
Present Employer: _________________________________________ Phone: # ____________________________
Address: _______________________________________________________ Position: ______________________
D. Do you have a valid First Aid Certificate? YES NO

E. Are you in good health? YES NO
Date of last medical: _____________________________ Family Physician: ________________________________
Height: __________________ Weight: _________________ Medical #: ___________________________________
Blood Type (if known): ______________________________ Allergies: ____________________________________
F. If you have not had a medical within the last year, would you agree to the City's appointed physician conducting same,
providing the City assumes the cost of the medical? YES NO
G. Are you afraid of heights? YES NO
H. Are you claustrophobic? YES NO
Terrace Volunteer Fire Fighters' Assoc. Application (cont.) Page 2
I. Have you ever been convicted of a criminal offence? YES NO

If YES, briefly state particulars:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
J. Would you grant permission for the City to conduct a criminal record search? YES NO
K. State briefly the reasons for wanting to become a Volunteer Fire Fighter:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
L. CHARACTER REFERENCES:
_____________________________________________________________________________________________
Name Address Phone
_____________________________________________________________________________________________
Name Address Phone
M. CLOTHING/APPAREL INFORMATION: Upon being accepted as a Volunteer Fire Fighter, we will need to arrange
for turnout gear, etc., could you please fill in as much of the following information as you can:
Hat Size: _____________ Shirt Neck Size: _______________ Shirt Arm Length: ___________ Jacket Size _______
Pants: Waist: ____________ & Inseam: ________________ Shoe Size: ______________ Shoe Width: __________
To the best of my knowledge, the above information is accurate.
__________________________________________________
Applicant's Signature
FOR OFFICIAL USE ONLY

Date Application Received: ________________________________
Comments:______________________________________________________________________
________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
____________________________________________________________________________
ACCEPTED/REJECTED as a Probationary Member _______________________________DATE

ACCEPTED/REJECTED as an Ordinary Member __________________________________DATE
Personnel Profile Completed: _________________________________________________DATE

Volunteer Firefighter Application Form

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TERRACE VOLUNTEER FIRE FIGHTERS' ASSOCIATION

APPLICANT NAME: __________________________________________________________________________________

AGE: __________ BIRTH DATE: _MARRIED/SINGLE: ______

A. Do you have a valid driver's license? YES NO

B. Do you have any previous fire fighting experience? YES NO

D. Do you have a valid First Aid Certificate? YES NO

I. Have you ever been convicted of a criminal offence? YES NO

FOR OFFICIAL USE ONLY

ACCEPTED/REJECTED as a Probationary Member _______________________________DATE

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