Emergency Support Services Volunteer Application Form

How did you learn about the New Westminster Emergency Support Services Volunteer opportunities?

Other:

Contact Information

First name

Last name

Other names you go by

Email address

Mobile phone #

Other phone #

Occupation

Work location

Home address

City

Postal code

Date of birth

General Information

Do you have a valid B.C. Driver's Licence?

No Yes

Do you have reliable transportation?

No Yes

Are you fluent in English (speak, read, & write)?

No Yes

Are you fluent in any other languages?

No Yes

Other languages you speak fluently:

Other languages you write fluently:

Emergency Contact Information

First name

Last name

Relationship

Home address

Email address

Mobile phone #

Other phone #

Professional References

Reference #1

Full name (first, last)

How do you know this person?

How long have you known this person?

Phone #

Email address

Reference #2

Full name (first, last)

How do you know this person?

How long have you known this person?

Phone #

Email address

Applicant's Declaration

I understand that I am required to be available day or night for callouts in one-week rotations, scheduled in advance.

I understand that I am to attend all ESS required training sessions.

I also understand that an appointment to any position is dependent upon successful completion of a Police Information Check.

I understand that any equipment, uniforms, protective clothing, training materials, or identification cards or badges which may be provided form my use, is the property of New Westminster Fire & Rescue Services — Emergency Support Program and must be promptly returned to the ESS Program Coordinator upon my leaving the program whether by resignation, dismissal, or any other means.

I understand that participation in department activities may make me privy to information about citizens of the fire protection area, members of the department, department activities, or other information of a personal or confidential nature and I will not reveal or discuss that information, except as required to carry out my duties as an ESS Volunteer.

I hereby certify that the information on this application is true and I understand that any untrue statements may be grounds for revocation of the application.

I agree that by clicking on the "Submit" button of this application I am effectively signing my application.

		NWFRS web site

		I attended a workshop/booth

		Partner agency

		I was engaged elsewhere

		Other

I want to...

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Emergency Support Services Volunteer Application Form

Contact Information

General Information

Emergency Contact Information

Professional References

Reference #1

Reference #2

Applicant's Declaration