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Volunteer Medical First Responder Application

Saddle Hills County

Name

Date of Birth

Mail Address

Phone (Home)

Phone (Cell)

Fax

Home location

CPR Expiry

Current Employer

Employed since

Previous employer (3 years)

Previous EMS experience

Training Courses (EMS or other):

Please provide two references and phone numbers where we can reach them

Please use one of the options below to sign this form electronically or, print off the filled-out form and email it to us at: protsrvcs@saddlehills.ab.ca.

1) Sign here with your cursor or sign in the space provided from your mobile device.

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2) Upload your electronic signature here

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3) Click here to sign

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Date of submission

Notice of Collection

The personal information on this form is being collected for the purpose of determining eligibility to serve as a Medical First Responder in Saddle Hills County and will be shared with Administration. The information is collected under the authority of Section 146 of the Municipal Government Act and Section 4 of the Protection of Privacy Act. For questions about the collection of personal information, contact admin@saddlehills.ab.ca or call (780) 864-3760.

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