Required fields are marked with asterisks (*)

Junior Firefighter Application

First name

Last name

Phone

Address

Town/City

Postal code

Emergency Contact Name

Emergency Contact Number

Reference 1

Name

May we contact this reference?

Yes

Reference 2

Name

May we contact this reference?

Yes

Personal information is collected under the authority of the Municipal Freedom of Information and Privacy Act and will be used for candidate selection purposes only. This application form complies with the Ontario Human Rights Code.

For questions regarding this application, please contact Emergency Services Headquarters at 905-318-5932, ext. 6224 or by e-mailing emergencyservices@haldimandcounty.on.ca

Applicant Signature

Please sign below. If applicant is under the age of 18, please have a parent or legal guardian sign.

Applicant or Parent/Guardian Signature

Clear