SPRINGHILL FIRE
APPLICATION FOR MEMBERSHIP
Age
Applicants must be 18 years of age or older to apply for membership with the Springhill Department. Applicants between the ages of 16 and 18 who wish to join our Junior Firefighter Program must visit the Springhill Fire Department on Tuesday evening with a parent or guardian to begin the application process.
Are you 18 or older?
Yes
No
Privacy
Prior to completing the application process, you will be asked to submit in person a recent Criminal Record check, as well as to provide your Social Insurance Number for insurance purposes. This information will be held in confidence. If selected to continue the application process, you will be directed to obtain the above check at no expense to you.
I understand that I will need to submit a Criminal Record.
Yes
No
I understand that I will need to provide my Social Insurance Number for insurance purposes.
Yes
No
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Personal Information
Name:
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
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2012
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1920
Year
Phone Number
*
E-mail Address:
Address:
*
Street Address Line 2
City
Postal / Zip Code
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Health
General health
Excellent
Good
Fair
Poor
Health conditions that may impact activities in the fire service
Allergies
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Education
Highest Grade Completed
12
11
10
9
8
7
6
5
4
3
2
1
Post Secondary Education
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Employment
Occupation
Employer
Length of Service
Location of Workplace
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Availability
Do you have transportation to the firehall?
Yes
No
Are you able to leave your work to attend to an emergency?
Yes
No
Are you able and willing to commit to 2-3 hours on Tuesday evenings for training, fundraising and meetings?
Yes
No
Are you able to periodically attend weekend training as offered by the Springhill Fire Department and the Cumberland Fire Service?
Yes
No
How many hours are you willing to commit to the Springhill Fire Department weekly?
2-4
4-6
6+
Are you willing and able to attend emergency calls late night/early morning?
Yes
No
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Previous Experience
Were you previously a member of another fire department?
No
Yes
Former Department
Rank Held
Length of Service
Previous Training
Reason for Leaving
Contact Information for Previous Department
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Reason for Applying
In a few words, please describe why you would like to become a member of the Springhill Fire Department
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References
Reference 1
Name:
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Years Known
Relationship
Reference 2
Name:
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Years Known
Relationship
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Sign Off
By proceeding past this point, you acknowledge that all information previously provided is accurate. Should you be selected to proceed in the application process, you will be contacted to arrange an interview.
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Name
*
First Name
Last Name
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