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Probationary Firefighter Application
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probationaryfirefighterapp
North Stormont Department of Fire Service & Emergency Services
15 Union Street, Box 99
Berwick ON K0C 1G0
Name:
Address:
Address:
City/Town:
Province:
Postal code:
Home phone:
Cell phone:
Email:
Date of birth:
Have you been a member of a fire department?
Yes
No
If yes, for how many years?
Where were you a member?
Do you have acrophobia (fear of heights)?
Yes
No
Do you have claustrophobia (fear of enclosed spaces)?
Yes
No
Would you agree to a medical examination?
Yes
No
Do you have a Class “DZ” driver permit?
Yes
No
Are you available to be called out both day and night?
Yes
No
If not both above, state which one you would be available:
Day
Night
Please state why you would like to join NSFS fire department:
Which Station are you applying for?
Stn. 1 - Finch Creek
Stn. 2 - Crysler
Stn. 3 - Avonmore
Stn. 4 - Moose
Signature:
Sign above
Date: