Spring 2017 CUEMS Membership Drive Application
Name (First and Last):
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Gender
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Phone Number
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Affiliation to Cornell
Year at Cornell
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College of Study
Major/Program of Study
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Reapplicant?
If yes, what semester did you apply previously?
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Do you have your driver's license?
If yes, when was the approximate date you were FIRST issued your license?
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Have you ever been in an accident? Were you at fault? Please be as honest as possible.
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Do you have any current applicable certifications (EMT, CPR, etc)?
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How many credits do you plan to take this semester?
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Are you involved in any other extra curricular activities?
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Do you anticipate working this semester (paid or unpaid)?
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Have you ever run with another ambulance agency or fire squad?
If yes, please tell us where, how long you have been active, and briefly describe your position on the squad, and your role on a typical call
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What unique qualities or characteristics could you contribute to our squad?
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Aside from helping the community and gaining clinical experience, what specifically about CUEMS excites you?
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Describe an instance that best exemplifies your persistence, determination, and willingness to work
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Describe a time when you went the extra mile
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How do you see CUEMS fitting into your schedule?
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Tell us about a time you made a mistake
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During which of the possible time slots are you available for a possible first round interview?
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If you have any additional information that you would like us to consider when reviewing your application, please add it here
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I understand that my application will not be considered if I do not attend a CUEMS information session
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