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.
Email (if applicable)
example@example.com
Emergency Contact Name & Phone*
Language Ability*

OjibweEnglishBoth
Can you read and write in one of these languages?*

YesNo
Driver Information

Tell us about your driving experience.
Do you have a valid driver’s licence?*

YesNo
Licence Class
Are you comfortable driving:

Pickup / SUVLarge TruckWater Truck / Fire ApparatusHeavy EquipmentNone yet – willing to train
Other relevant skills
Training & Experience

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

SP100 WildlandStructural Firefighter TrainingFirst Aid / CPREMR / MedicalHeavy EquipmentRanger / Military / Emergency ServicesMechanical / TradesOther
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)?*

YesNo
Are you willing to attend regular training?*

YesNo
Are you willing to be on call and respond when available?*

YesNo
Conduct & Eligibility

Please confirm the following statements.
Please confirm the following statements:*

I live in Pikangikum or the surrounding area.I am not currently charged with a criminal offence that would prevent me from serving safely.I am not currently an active operational member of another fire department without approval.I do not use illegal drugs.I will not report for duty impaired by alcohol or substances.I understand this is a community response role and response is voluntary but serious.I am willing to follow department rules and leadership.
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:

Pikangikum Fire Rescue Membership Application

Personal Information

Driver Information

Training & Experience

Fitness & Availability

Conduct & Eligibility