Required fields are marked with asterisks (*)

Firefighter Application Form

Please complete this form in its entirety and submit the information.

First and last name

Primary phone number

Street address

Town

Postal code

Length at current address?

E-mail address

Present Employer

Employer's Full Address

Nature of Employment?

Length of Employment?

Does your job include shift work?

What hours do you work?

Will you be able to get permission to leave work for an emergency response?

What is your availability to respond to an emergency response?

Please list education, certificates, special training that would apply to the position of Firefighter.

Please list community involvement and interests.

Do you have a valid drivers licence?

Class of current valid drivers licence?

Are you willing to upgrade to a DZ licence at your own expense?

Have you ever been convicted of a driving offense

Yes

If yes, please describe.

Have you ever served on another Fire Department? If yes please list location and years of served.

Are you able to preform the duties of a Firefighter as listed on the website?

I understand that if selected to be a firefighter for FDNH, I agree to have a Police Record Check done and hand into the Chief or Deputy Chief before beginning.

I agree

I understand that if falsification of statements, misrepresentation, deliberate omission or concealment of information may be considered for just cause for refusal of this application.

I agree

I affirm and certify that the information given on this application is correct.

I agree

Police Record Checks are mandatory for all applicants. If notified for an interview, please bring it with you.

Signature of Applicant

Clear

Date of Signature