Recruitment

Section 1: Personal Information

Name *

Phone Number *

Email Address *

Are you 18 years or older? * Yes
No

Next of Kin (or Emergency Contact) *

Phone Number *

Do you have access to a vehicle? * Yes
No

Driver's License *

Class *

Airbrake Endorsement * Yes
No

Section 2: Employment Experience

Employer *

Occupation

Location

Were you ever a member of another fire department? * Yes
No

Do you have any health conditions or limitations? * Yes
No

Are you able to leave work to attend emergency calls? * Yes
No

Do you anticipate any problems/conflicts attending the following activities:

Are you able to attend Tuesday Night Training? * Yes
No

Emergency Calls? * Yes
No

Section 3: References

Name *

Phone Number

Relationship

Name *

Phone Number

Relationship

Selected applicants must provide a criminal background report and a driver’s abstract report. Any cost for obtaining these documents will be reimbursed by Buckland Fire/Rescue.

I hereby agree to adhere to the by-laws, policies and procedures of Buckland Fire/Rescue. I further agree to respond to emergency calls and to actively participate in meetings, training sessions and other department activities when available.

Completing your name in the "Signature" field will act as your digital signature.

Signature (Please Type Your Name) *

Date *

Buckland Fire/Rescue is an equal opportunity employer. This information is collected under the Freedom of Information Act and is required to process your application for employment with Buckland/Fire Rescue. All information submitted on this form will remain confidential.