Cortes Island Volunteer Firefighter Application Form

Cortes Island Volunteer Firefighter Application Form
Personal Information
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Home/Work Phone*

Area CodePhone Number
Email*
example@example.com
Residence Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*
Eg. dd-mm-yyyy
SIN*
000-000-000
Date of Birth*
dd-mm-yyyy
SIN
000-000-000
Driver's License # (BC)*
DL Class & Endorsements
Eg. Class 5
Uniform Measurements
Height
Eg. 5'11"
Waist
Inches
Inseam
Inches
Shoe Size
Eg. Men's 11, Women's 7
Education & Occupation
Education
Occupation
Present Employer
Or indicate if self-employed
Supervisor
Full Name
Work Hours
Eg. 8am - 4pm
Qualifications
Do you currently live on Cortes Island?*
Do you have a valid BC Driver’s License and a good driving record?*
Do you believe you are free of medical conditions that may preclude your participation as a volunteer firefighter?*
Are you willing to participate in a medical check if required?*
Do you understand that volunteer firefighters are expected to be in good physical condition, and do you feel you are physically able to participate in a physical fitness test?*
Do you understand that successful applicants are required to remain without facial hair to ensure a self-contained breathing apparatus mask will form a positive seal on the face?*
Additional Comments
Availability
If accepted by the Fire Department, you will be expected to attend regular weekly Tuesday night practices (approximately 7:00PM to 9:00PM). Can you meet this requirement? *
Do you understand that in order to be available for emergency call-outs, you must be able to arrive at the fire station promptly in a sober and alert condition?*
Are you willing and able to participate in occasional weekend training programs?*
Skills and Experience
I grant the Cortes Fire Department permission to take and use photograph(s) of me for educational and promotional materials, social media posts, the cortesfire.org website, and press releases.*
Please indicate if you have any of the following skills or training*

CPR / AEDCertified Trade - Mechanic, Electrician etc.Fire Safety Systems - Alarms, Extinguishers etc.Rescue Training - Lifeguard, Search & Rescue etc.First Aid / Medical TrainingKnowledge of Breathing Apparatus - Scuba Diving, etc.Other
Do you have any of the following skills or training?

Firefighting related experience or certifications (please list below)Other relevant experience (please describe below)
Previous Firefighter Experience – Explain:
Other Relevant Experience – Explain:
Declaration
I agree to abide by the IAFF Firefighter Code of Ethics (attached below).

I understand that Firefighting is a stressful and inherently hazardous activity.

I will exercise due caution and care for myself and others, follow the directions of my supervisors and the fire chief.

I understand that I have a right and responsibility to refuse unsafe work, and must communicate such refusal to my immediate supervisor.

I will not respond to an emergency call-out if I am under the influence of alcohol or mind-altering substances, and understand that doing so is grounds for immediate dismissal.

I certify that all the information submitted in this application is truthful and correct. I understand that if I provide information in connection with my application which is found to be untrue or incomplete, my application may be rejected or I may be subject to dismissal from the department.

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The personal information on this form is collected under the authority of s.26 of the Freedom of Information and Protection of Privacy Act. This information will be used for the purpose of determining the suitability of applicants for the position of volunteer wildland firefighter.
Date

MonthDayYear
Date
Signature
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Cortes Island Volunteer Firefighter Application Form

Personal Information

Uniform Measurements

Education & Occupation

Qualifications

Availability

Skills and Experience

Declaration