Application

We are looking for new members now, trained or untrained. If interested in joining be sure to stop by our station, or fill out the application below.

"*" indicates required fields

Application Requirements*

Thank you for your interest in our organization. Please be aware that public safety work requires a very high level of attention to detail as well as the ability to document your work. This application is used as an evaluation of your ability to complete required documentation. The information requested in this application is the minimum needed information for us to began the process of considering your eligibility for employment and/or volunteer work with our agency. In order for your application to be considered all of the information requested on this form must be completed. Thank you,

I have read and understand the above statement.

Name*

Email*

Home Address*

Phone*

Date of Birth

I have five years of employment history?*

Yes

May we contact your most recent employer?*

Yes

If you answered "no," please briefly explain below

Resume Requirements (if not met your application will not be processed)*

Your resume MUST include; a list of education and training you have completed or are currently enrolled in that applies to Emergency Medical Services, a list of certifications, credentials, or licenses held that apply to Emergency Medical Services, a list of past employment, and a minimum of 1 professional reference and 1 personal reference.

I have read and understand the above statement.

Resume or Certification(s)

Drop files here or

Accepted file types: pdf, jpg, png, doc, docx, Max. file size: 256 MB.

Please upload an electronic versions of your resume and any certifications you have that apply to the position you are seeking.

Additional Experience / Information

Please list/describe any additional experience or information that is not included in your resume that could be relevant to you being a member of OUR Team.

Medical Information

Please list / describe any medical conditions (including medications) which may prevent or impair your ability to perform tasks as a staff member in a prehospital setting:

Desired Position*

Check all that apply

Full Time - Career (Paid)

Part Time - Career (Paid)

EMS - Volunteer

Signature*

This is to certify that I, the above-signed, freely and voluntarily offers themselves to his fellow man regardless of race, creed, or color. It is to be clearly understood by this applicant that he/she is required to be available for call at any hour, day or night, providing that it does not interfere with his/her work or business. If the applicant is granted membership, he/she will be governed by the constitution and by-laws of this organization. The applicant’s signature on this application grants this organization permission to verify all information and conduct criminal background and DMV history reports. Any information being found falsified will be grounds for denial.

Phone

This field is for validation purposes and should be left unchanged.

Application

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