Volunteer Application Form SECTION A: NAME AND CONTACT INFORMATION First Name* Last Name* Home Phone Cell Phone (Required for IAM Responding Call Out App)* Cell Phone Provider (e.g. Telus, Bell, Rogers)- Required for IAM Responding Call Out App* Email* (Required for IAM Responding Call out App) Mailing Address Address Line 1 Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanYukonNunavutNorthwest Territories Postal Code Country Apex Mountain Physical Address (For Apex Part-Time or Full-Time Residents) Address Line 1 Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanYukonNunavutNorthwest Territories Postal Code Country SECTION B: EDUCATION, SKILLS AND PREVIOUS EXPERIENCE A wide range of skills are required to effectively operate a modern fire and rescue organization. Please provide the education and/or skill set(s) that you are willing to offer in supporting the operations of the Apex Fire Brigade Society Please select all skills that apply, or provide additional skills in "other" AccountingArchitectAnimal Health TechAnimal RescueBiologist/ BiologyBook KeepingBuilding InspectionBusiness/ Organization AdministrationCamp Set-Up/ OperationsCarpenterChainsaw Operator/ FallerChemist/ Chemical EngineeringClericalCoachingConstructionDrafting/DesignDisaster Response/ ManagementElectricianElectric UtilityEmergency Social ServicesFinanceFire AlarmsFire InspectionFire Sprinkler SystemsFirst AidFood Preparation/ Cooking/ CateringForestry/ ForesterFundraisingGarment Repair/ SewingGas FitterGas/ Propane UtilityGIS Spatial AnalysisGrant WritingHazMatHeavy Equipment OperatorIT/IMMechanic/ Vehicle RepairMillwrightNursingParamedic/ EMTPipefitterPlumberProfessional DriverPublic RelationsPsychology/ CounsellingRefrigeration SystemsGround SearchSchedulingSmall Engine RepairStructural Engineer/ Structural DesignStructural FirefighterSwiftwater RescueRope Rescue/ Rope Access/ Rock Climbing/ Apline ClimbingTeacher/ InstructorUrban RescueVehicle ExtricationVeterinarianWarehouse Operations/ InventoryWeb DesignWildland Firefighter Other Skill(s) SECTION C: VOLUNTEER ROLE SELECTION I would like to volunteer on the following committees ( select all that you are interested in) Outreach and Communications Committee (responsible for supporting both internal membership communications and external public communications and outreach under the direction of the AFBS board of directors)Fundraising Committee (responsible for implementing and coordinating a fundraising strategy, including seeking, and applying for grants under the direction of the AFBS board of directors)FireSmart Committee (responsible for the development of a community wildfire preparedness program under the joint direction of the AFBS board of directors and the Apex Community Association board of directors)Equipment Support Committee (responsible inventory and maintenance of AVFR equipment under the direction of the Fire Chief or designate)Emergency Planning Support Committee (responsible for supporting the development and implementation of various emergency response plans under the direction of the Fire Chief or designate)Training Support Committee (responsible for supporting the development and implementation of the AVFR training plan under the direction of the Fire Chief or designate)None I am applying to volunteer for the following emergency call-out support (non-firefighter) positions ( select all that you are interested in) Emergency Social Services (under the direction of the Fire Chief or designate, responsible for providing supply, service and social support to the public and residents who are affected or displaced as a result of an emergency incident)Fire and Emergency Operations Logistics Support (under the direction of the Fire Chief or designate, responsible for providing supply and service support during emergency response operations under the direction of the Fire Chief or designate)Fire and Emergency Operations Planning Support (responsible for providing planning support during emergency response operations under the direction of the Fire Chief or designate)None I am applying to volunteer as a firefighter and have read the volunteer firefighter job description Yes- (YOU MUST ANSWER ALL OF THE BASIC FIREFIGHTER QUESTIONS IN SECTION D) OF THIS FORM - I would also like to volunteer on the committees that I have identified in QUESTION 8No- I would like to only volunteer for the positions that I have identified in QUESTION 8 and/or 9 CLICK HERE TO READ THE VOLUNTEER FIREFIGHTER JOB DESCRIPTION Do you understand that you have the right to refuse any work or task that you perceive as unsafe, or you are not physically capable of safely performing while undertaking your duties as a volunteer AFBS member?* YesNo Are you willing to always make safety your first priority while undertaking the duties of a volunteer AFBS member?* YesNo SECTION D: BASIC FIREFIGHTER REQUIREMENTS Do you live full-time, year-round within the Apex village?* YesNo- I reside part-timeNo- I do not have a residence at Apex If you live part-time at Apex, how many days per year are you typically here? If you live part-time at Apex,what months are your typically here? Do you work in the Apex village year-round? Please explain* Are you 19 years of age or older?* YesNo Do you believe that you are free of medical conditions that may preclude your participation as a volunteer firefighter and undertake the duties of a volunteer firefighter as described in the volunteer firefighter job description?* YesNo CLICK HERE TO READ THE VOLUNTEER FIREFIGHTER JOB DESCRIPTION Are you willing to complete a self-declaration for medical fitness? * YesNo Are you willing to undertake a vulnerable population criminal record check?* YesNo Do you have a current BC Class 5 non-restricted driver's licence?* YesNo Do you have a current BC Air Brake Endorsement?* YesNo Are you willing and able to participate in a 2.5 hour practice session on the first and third Tuesday of each month and maintain either a Class A or Class B membership (select Class A, or Class B below)* YesNo Select One: Class A members: A MINIMUM annual attendance rate of 60% or greater AND maintain currency on all exterior firefighter and first responder qualificationsClass B members: A MINIMUM requirement of maintaining currency on all exterior firefighter and first responder qualifications *Class A members will have first priority to equipment upgrades, training promotions and other opportunities over class B members Do you understand that in order to be available for emergency call-outs, you must be able to arrive at the fire station promptly and not be under the affects of alcohol or drugs?* YesNo Are you willing and able to install the IAM Responding application on your mobile device and respond to emergencies 24 hours per day, seven days per week, 365 days per year? * YesNo Are you willing and able to participate in the occasional weekend training program ?* YesNo Please place a check mark next to the times that you are typically at Apex and available to respond to emergencies: Midnight to 6 AM 6 AM to 6 PM 6 PM to Midnight Sunday Yes Yes Yes Monday Yes Yes Yes Tuesday Yes Yes Yes Wednesday Yes Yes Yes Thursday Yes Yes Yes Friday Yes Yes Yes Saturday Yes Yes Yes Do you understand that volunteer firefighters are expected to be in good physical condition to accomplish the tasks listed in the volunteer firefighter job description?* YesNo CLICK HERE TO READ THE VOLUNTEER FIREFIGHTER JOB DESCRIPTION Do you understand that successful applicants are required to remain without facial hair to ensure a self-contained breathing apparatus mask will form a positive seal on the face?* YesNo Are you willing to follow the Apex Fire Brigade Society policies, training standards, directives and standard operating guidelines?* YesNo Are you willing to follow the Apex Fire Brigade Society chain of command structure and follow direction provided by the Fire Chief or designate supervisor* YesNo SECTION E: SIGNATURE Please read carefully: I, the undersigned, apply to enroll as a volunteer recruit member of the Fire Department and, if accepted, undertake to perform such duties as may be assigned to me by the Board of Directors and/ or Fire Chief or delegated representative. I understand that this is a volunteer position with no remuneration. I understand the promotional opportunities will depend upon positions becoming available, the results of work performance, training evaluation, the recommendation of the Board of Directors and/ or Fire Officers and approval of the Fire Chief. I verify that the information contained on this application form is true and accurate. I hereby give consent to the Apex Fire Brigade Society to conduct verification of the information given, as required. I agree to the above