Fillable FORM APPLICATION One application form per course (Please (University College of Saint-Boniface)

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FORM APPLICATION One application form per course (Please (University College of Saint-Boniface)

On average this form takes 9 minutes to complete

The FORM APPLICATION One application form per course (Please (University College of Saint-Boniface) form is 1 page long and contains:

  • 1 signature
  • 6 check-boxes
  • 29 other fields

Country of origin: CANADA
File type: PDF

Canada forms for University College of Saint-Boniface

BROWSE UNIVERSITY COLLEGE OF SAINT-BONIFACE FORMS

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___________________________________________________________________________________________________________________
Office of the Fire Commissioner
1601 Van Horne Avenue East
Brandon Manitoba
Canada R7A 7K2
Phone: (204) 726-6855
Fax: (204) 726-6847
Toll Free: 1-888-253-1488
mescocr@gov.mb.ca
www.firemedic.ca
STUDENT COURSE
APPLICATION
FORM
“
Training to Save Lives”
Rev. May 2015
Please ensure that all sections are completed. Incomplete forms will be returned. Photocopied forms will be accepted. All personal information
contained on this form is necessary for the efficient operation of the Manitoba Emergency Services College Records Management System and is
strictly confidential. It is protected by the Protection of Privacy provisions of the Freedom of Information and Protection of Privacy Act.
ALL
INFORMATON MUST BE COMPLETED OR THE APPLICATION WILL BE REJECTED AND THE INDIVIDUAL WILL NOT BE REGISTERED ON
THE COURSE.
One application form per course (Please print clearly)
Course Title
Course Location
Course Date(s)
I have previously attended an MESC course: Yes No
Personal Information (as it will appear on MESC correspondence, certificates & documents)
FAMILY NAME
FIRST NAME
HOME Mailing Address
Box Number
Postal Code
/ / Female First Nations Inuit
YEAR MONTH DAY
BIRTHDAY Male Metis Visible Minority (Non-Caucasian)
Fire Department / Regional Health Authority / Business/ Mutual Aid District
Affiliation Name
Mailing Address
City/Town/Province
Postal Code
Mutual Aid District
Date of Application ______________________________ Signature of Applicant ____________________________
City/Town/Province
Cell Phone
E-mail Address
Emergency Contact Name & Phone:
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FORM APPLICATION One application form per course (Please (University College of Saint-Boniface)

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Completed 23 May 2021

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