- Sasamat Fire Department

Name (First, middle, last)

Address

Phone

Email

Confirm Email

Choose Accommodation Type

Transportation Options

I own a vehicle
I have access to a vehicle
I do not have access to a vehicle

I confirm I am medically fit to undertake physically demanding tasks and can meet the requirements of the PAR Q questioner, that can be found at http://www.csep.ca/forms.asp. I am able to supply a physicians note prior to training.

I confirm
I cannot confirm

I can respond to calls (choose as many as apply)

Please explain your education level and year(s) completed

Please outline below all relevant education, training and certification related to fire fighting, first aid and physical fitness

to I last)

References:

STATEMENT: The information provided on this application is true to the best of my knowledge. I agree that the Sasamat Volunteer Fire Department has the right to confirm this information. I understand that any false or omitted information may be sufficient grounds for immediate discharge from the department

I Confirm