Application Form

Date: __________________________

Name: __________________________ Date of Birth: _________________

Address: Box ___________________ Drivers Licence # ________________

Street ________________ Class: __________

Magrath, AB. T0K 1J0

Phone: _________________________ Social Insurance # ____ ____ ____

Minimum age for acceptance into active duty is 18 years.

Please answer the following questions with ‘yes’ or ‘no’ and give additional explanations where necessary.

1. Are you willing to follow the rules, regulations, and

protocols of the Magrath Fire Department? _____

2. Do you have any physical limitations which might interfere with

your performance as a volunteer firefighter? _____

If Yes explain. _____________________________________________

3. Special skills or training (check those applicable or specify)

First Aid ___ CPR ___ EMR ___ EMT-A ___ Others ______________

Firefighter courses _________________________________________

Trade Qualifications (e.g. Mechanic) ________________________

4. Additional Comments _________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Signature of Applicant __________________________ Date ___________

Application re: FIRE DEPT ______ AMBULANCE ______ RESCUE ______

Submit c/o: Town of Magrath, Town Administrator

Box 520, 55 South 1st Street West

Magrath, AB T0K 1J0 tel (403) 758-3212

----------------------- For office use only ----------------------

Application Reviewed by: ________________________ Date ___________

Approved _____ Rejected _____