Pikangikum Fire Rescue Membership Application

Pikangikum Fire Rescue Membership Application

Apply to join Pikangikum Fire Rescue as a volunteer member. Please complete all required sections honestly and carefully and send. Any questions please email recruiting@PikFire.ca
Personal Information

Tell us about yourself.
Full Name

First NameLast Name
Date of Birth (Must be 18+)

MonthDayYear
Date
Address in Pikangikum

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email (if applicable)
example@example.com
Emergency Contact Name & Phone
Language Ability
Can you read and write in one of these languages?
Driver Information

Tell us about your driving experience.
Do you have a valid driver’s licence?
Licence Class
Are you comfortable driving:
Other relevant skills
Training & Experience

Check all that apply.
Please indicate your training and experience:

Other
Fitness & Availability

Tell us about your ability to serve.
Are you physically and medically able to safely perform firefighting duties, with or without corrective devices (e.g., glasses, hearing aids)?
Are you willing to attend regular training?
Are you willing to be on call and respond when available?
Conduct & Eligibility

Please confirm the following statements.
Please confirm the following statements:
Applicant Signature
Date

MonthDayYear
Date
Applicants must not be actively using illegal drugs or impaired by alcohol when responding. Must not have criminal charges.
Should be Empty: