Iqaluit Fire Department

● IQALUIT FIRE DEPARTMENT ● CITY OF IQALUIT – APPLICATION FOR EMPLOYMENT

POSITION FIREFIGHTER VOLUNTEER DESIRED MEDICAL SERVICES FULL-TIME DISPATCH CASUAL

APPLICANT’S SURNAME GIVEN NAMES

ADDRESS:

POSTAL CODE: HOME TELEPHONE: OTHER TELEPHONE:

( ) ( ) ARE YOU LEGALLY HAVE YOU EVER BEEN FROM TO ENTITLED TO WORK YES EMPOLYED BY THE YES CITY OF IQALUIT NO ______IN CANADA NO IF “YES” WHAT DEPT ? MM YY MMYY HAVE YOU PREVIOUSLY APPLIED FOR A POSITION WITH THE IQALUIT FIRE DEPARTMENT YES NO

IF YES, WHEN? ______

EMPLOYMENT (Beginning with your present employer – list all jobs including part-time HISTORY positions) COMPANY NAME: PRESENT/LAST POSITION

ADDRESS NAME OF SUPERVISIOR SUPERVISIOR NUMBER 1. CITY PROV POSTAL PERIOD OF EMPLOYMENT ______TO ______MM YY MM YY TYPE OF BUSINESS REASON FOR LEAVING

COMPANY NAME: PRESENT/ LAST POSITION:

ADDRESS: NAME OF SUPERVISIOR SUPERVISIOR NUMBER

CITY PROV POSTAL PERIOD OF 2. EMPLOYMENT ______TO ______MM YY MM YY

TYPE OF BUSINESS: REASON FOR LEAVING: ● IQALUIT FIRE DEPARTMENT ● CITY OF IQALUIT – APPLICATION FOR EMPLOYMENT PAGE 2 COMPANY NAME PRESENT/LAST POSITION

ADDRESS NAME OF SUPERVISIOR SUPERVISIOR NUMBER

CITY PROV POSTAL PERIOD OF 3. EMPLOYMENT ______TO ______MM YY MM YY TYPE OF BUSINESS REASON FOR LEAVING

PERSONAL DATE OF BIRTH SOCIAL DRIVER’S CLASS PROV INSURANCE LICENCE INFORMATION NUMBER ______19__ EDUCATION ELEMENTARY/SECONDARY: CIRCLE THE HIGHEST YEAR SUCCESSFULLY COMPLETE: 1 2 3 4 5 6 7 8 9 10 11 12 13 INDICATE MAJOR SUBJECT OR SPECIALIZATION: TYPES OF SCHOOL TYPE OF YEARS DIPLOMA/ PROGRAMS COMPLETE CERTIFICATE OBTAINED SECONDARY UNIVERSITY OTHER(TRADE, NIGHSCHOOL, ETC.) ARE YOU CURRENTLY ENROLLED IN ANY COURSES? YES NO DO YOU HAVE A VALID FIRST AID CERTIFICATE? YES NO DO YOU HAVE A VALID CPR CERTIFICATE? YES NO DO YOU HAVE ANY OTHER CERTIFICATION, SKILLS OR EXPERIENCE THAT PERTAINS TO THE FIELD OF EMERGENCY SERVICES? PLEASE LIST BELOW

REFERENCES NAME: NAME: ADDRESS: ADDRESS: PHONE NUMBER: PHONE NUMBER:

I affirm that all information given herein is true and correct I hereby authorize the investigation of all statements made herein in and understand that any misrepresentation or falsehood is cause for dismissal.

______/20_____ SIGNATURE DATE

* Please note: Resume and application must me submitted together with a criminal records check