Kirkland Lake Volunteer Firefighter Application
Confidential when completed
Last Name, First Name, Initial
Home Phone, Cell Phone, Business Phone (please include all)
Name and Phone Number
Email Address
Name, Address, Phone
Indicate skill level by indicating the appropriate number and providing an explanation.
1 – A trade, license, recognized certificate or extensive experience.
2 – Advanced skills level and/or post secondary courses or apprenticeships.
3 – Familiarity acquired through personal experience, high school courses or related training.
Please provide an accompanying resume and copies of all licenses, diplomas or certificates.
A Police Records Search Certificate must be provided with this application.
I affirm and certify that the information given on, or attached to; this application is true and correct. I understand that any falsification of statements, misrepresentation, deliberate omission or concealment of information may be considered just cause for immediate dismissal.
I authorize the Kirkland Lake Fire Services to contact my references or previous employers as indicated and to obtain and review my medical assessment.
Please type in your full name for your electronic signature
By selecting "I Accept" using any device, means or action, you agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing.
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.