APPLICATION FOR MEMBERSHIP COMPLETE ALL FORMS IN BLUE OR BLACK INK

Transcription

1 Basic Applicant Data: Surname District of Coldstream Fire Department APPLICATION FOR MEMBERSHIP COMPLETE ALL FORMS IN BLUE OR BLACK INK Given Name(s) Date of Birth - Age / / / - years Occupation D/M/Y Canadian Citizen (Yes or No) Permanent Resident (Yes or No) Gender Male Female Beneficiary Marital status Tel Nos H home W work C - Cell (s) Address Street Community T(H) ( ) - T(W)( ) - C( ) - Spouse Recommended by Postal Code Basic Applicant Criteria: No Person shall be elected to membership who is not a Canadian Citizen or Permanent Resident of Canada, who has ever been convicted of a crime, or who cannot read or write the English language Applicant Attestation: I (please print full name) being a Canadian Citizen or Permanent Resident of Canada, hereby make application to become a member of the Lavington Volunteer Fire Hall, and if accepted, promise to abide by the Bylaws, and obey all orders from the duly elected Fire Dept Officers while on duty. Also, whenever possible, I will attend all emergency paged call outs and practices, and do my utmost to assist in saving life and property. I also declare that to the best of my knowledge and belief I am of sound mind and in good general health. Applicant signature: Date:

2 Employment Information: Social Insurance No Criminal Record LFH check off: Check Form (required completed and attached with form return) Work Experience - Firefighting Years of experience/ Posns/ranks District of Coldstream Fire Department Military Driver s Licence No ICBC Driver s Abstract (required with this form when returned) LFH check off: Police Industrial Professional Business Medical Volunteer Other Current Employer/employment status

3 Education and related Training Experience: Education High School University/College Trades School/Quals Related Training Fire fighting/safety First Aid (Level /Expiry date) Medical WHMIS Food Safety Driver Heavy Equip Operator Air Brakes HAZMAT Search & Rescue Communications Emergency Response Mechanic/Equip maintenance Technical Other

4 APPLICANT QUESTIONNAIRE Applicant name: Why do you want to be a Volunteer firefighter? Do your enjoy your family s support in becoming a firefighter? Are you and your family prepared for the time commitment and duties/risks involved? What do you offer to bring to the Fire Dept list your strengths Are you (or have you been) a member of any other volunteer organization? Questions for applicant s spouse/partner Are you aware of your spouse/partner s time commitment for Fire Dept calls, training and events? Do you support your spouse/partner s commitment? Do you have any concerns about your spouse/partner joining the Fire Dept? Would you consider involvement in Fire Dept community and social events? Applicant signature Applicant spouse/partner signature

5 APPLICANT ASSESSMENT REPORT FIRE HALL RECRUITMENT COMMITTEE The Lavington Fire Hall Recruitment Committee have inquired into the character, health and general suitability of Mr/Mrs/Ms And find him/her suitable / unsuitable (cross off as appropriate) as a candidate for membership with the Lavington Fire Hall. An offer of Probationary Membership will be made to suitable candidates depending upon available positions within the Fire Hall. Should positions not be immediately available candidate names may be placed on a Fire Hall Waiting List. Signed: Terry Garrington Chief, Lavington Fire Hall Brian Donovan, Captain, Company 1, Lavington Fire Hall Ivan Soroka, Captain, Company 2, Lavington Fire Hall

6 LAVINGTON FIRE HALL RECRUITMENT PROCESS STAGE 1: (LFH RECRUITING COMMITTEE- LFH Officers: Fire Chief, and Fire Hall Captains) 1. Initial interview with applicant. 2. Provide applicant with recruitment package including application forms for completion upon successful interview. STAGE 2: 3. Second applicant interview after return and review of completed application package by applicant. 4. Upon recommendation of LFH Recruitment Committee and endorsement vote by LFH membership successful candidate is offered probationary membership and commences on the job familiarization training as a Recruit Firefighter. Initial equipment issue. STAGE 3: 5. Recruit Firefighter may attend fire hall practices and events as part of initial familiarization training but cannot respond to paged emergency fire calls until successful completion of the Recruit Firefighting Training Course at the Fire Training Centre. 6. Upon successful graduation from the Recruit Firefighter Training Course, Recruit Firefighter will be placed on a three-month probationary period for further on-the-job training and observation. STAGE 4: 7. A review of Recruit Firefighter probationary performance and interview by the LFH Recruitment Committee with the Recruit Firefighter is conducted at completion of the Probationary Period. 8. Upon recommendation of Recruitment Committee the Recruit Firefighter is accepted as a permanent member of the LFH with endorsement vote by LFH membership.

7 Dear Applicant, District of Coldstream Fire Department GENERAL INTRODUCTION LETTER FOR APPLICANTS Thank you for your expressed interest in becoming a volunteer firefighter with the Lavington Volunteer Fire Hall. If successful in joining our volunteer team you will become a vital member of our community s ability to respond to emergencies of all types and scales. While the Fire Department s primary function is protecting the community from the threat of fire we also respond to other emergencies such as vehicle accidents, power line failures, chemical spills and any other threat to public safety deemed to need our response. You will also have the opportunity to participate in community and charity events supported by the Fire Department. At the same time, you will receive formal and on-the-job training in all aspects of being a Fire Fighter and the Fire Department s operation. Most importantly, you will become a member of a dedicated team of volunteers made up of your fellow residents who share a common cause in their willingness to serve their community. The Lavington Fire Hall conducts a practice evening from 7:30 to 9:30 p.m every Tuesday. The first Tuesday of each month is dedicated as a monthly general meeting and is preceded by fire equipment maintenance checks commencing at 6:30 p.m. Attendance at these fire practice nights is registered and you will receive an annual onetime payment (practice and fire call pay rates info will be provided) for accumulated practice night hours and all other hours logged on fire calls and other fire department duties approved for payment. Included in this Recruitment Package is a complete set of LFH Application for Membership forms which you will be required to complete and return to the Fire Hall. Included in the application for membership process is a requirement for a medical assessment with a Physician s recommendation of medical fitness. You will also be required to submit a completed Criminal Record Check form and ICBC Driver s Abstract. A description of the entire Fire Fighter recruitment process is attached to this letter for your information. Best wishes in your efforts to become a Volunteer Fire Fighter with our Fire Hall! Sincerely, Terry Garrington, Fire Chief, Lavington Fire Hall District of Coldstream Fire Dept.

8 Medical Fitness Form: To be completed IN INK after examination by a Physician Applicant Given Name(s) Surname Date of Birth(D/M/Y) / / / Address Basic Medical Data Height Weight Posture Eye sight Squint Vision (No Glasses) O.D 20/ O.S 20/ With Glasses O.D 20/ O.S 20/ Hearing Right Left Oral Hygiene Good Fair Poor Evidence of following. Please indicate by Yes or No Hernia Back trouble Asthma Chronic Respiratory Fainting Spells Disease Dizziness Heart Trouble Amputation Epilepsy Diabetes Hypertension History of previous illness Details of physical impairment (please be specific How long have you known/been applicant s physician Does applicant have a nervous problem? yes or no Does applicant have any drug/alcohol problem?-yes or no Is the applicant on any ongoing medication? Yes or no Years/months Comments Comments Comments First Visit? Yes or No Applicant release of medical information attestation: I (applicant name), hereby authorize Dr to release any information concerning my medical history or any other information requested to the Lavington Fire Dept. Physician attestation of Applicant s medical fitness: In light of the contents and your examination findings DO YOU CONSIDER THE APPLICANT TO BE SUITABLE TO RENDER SERVICE TO THE LAVINGTON FIRE DEPARTMENT? YES NO DATE (D/M/Y): / / Signature: M.D Address: