Firefighter/Paramedic Application Form

Personal Information

Last Name

First Name

Street Address

City & Province

Telephone Number (Home)

Telephone Number (Cell)

Employment Information

Position applied for:

Position Title

Full time?

Full-time

Part-time

Currently or previously employed by the Town of Riverview? *

Yes

Department

Position

Reason left

Dates employed (from/to)

In which language(s) do you have proficient working ability?

English

French

Other

Other Language(s)

Education

Do you possess a high school diploma or GED? *

Yes

Please attach proof *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp tif pdf doc docx.

Have you successfully completed the International Fire Service Accreditation (IFSAC) or Proboard NFPA Firefighter Level II program? *

Yes

Please attach proof *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp tif pdf doc docx.

Have you successfully complete the Canadian Medical Association Primary Care Paramedic (PCP-1) Program? *

Yes

Please attach proof *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp tif pdf doc docx.

Do you possess certification with the NB Paramedic Association? *

Yes

Please attach proof *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp tif pdf doc docx odt.

Do you possess a valid Class 5E driver’s licence? *

Yes

Please list any additional licences or certifications:

High School

Degree/Diploma

Level Completed

Years Attended (from- to)

Location

Community College

Degree/Diploma

Level Completed

Years Attended (from- to)

Location

University

Degree/Diploma

Level Completed

Years Attended (from- to)

Location

Please list other formal training completed:

Please list additional skills and equipment you can operate efficiently:

Employment History: Begin with most recent
Employer	Position	Location	Employment period (from-to)	Supervisor Name & Contact:	Duties
Employer	Position	Location	Employment period (from-to)	Supervisor Name & Contact:	Duties

I certify *

I certify that the information provided in this application is true and accurate. I understand that the withholding of information on this application or on my resume will result in a refusal to fire or in disciplinary action up to an including termination of my employment.