ATCO Fire Cadet Program

County of Grande Prairie Regional Fire Service

Junior Firefighter Application Form

Full Name:

Date of Birth:

Email Address:

Rural (Physical) Address:

Is your physical address different from your mailing address?

Yes

No

Town/City

Postal Code

Emergency Contact Name (Next of Kin):

Emergency Contact's Phone (Home):

Emergency Contact's Phone (Other):

School Attended:

Grade Completed

Employer:

Occupation:

Normal Work/School Days/Hours (if shift, please explain):

Do you have a method of transportation?

Yes

No

Are you available for Practice Nights (evenings between 18:00-22:00 hours)?

Yes

No

Are you able to attend weekend training?

Yes

No

Do you have previous Fire Department experience?

Yes

No

Have you taken any courses related to Fire or Rescue?

Yes

No

Have you taken the following?

First Aid

CPR

Firefighters are required to carry, lift, climb, crawl, and bend. Do you have physical limitations that would prevent you from performing these duties?

Yes

No

Are you a member of any other community group?

Yes

No

What interested you in applying with the Fire Service?