RRS Membership Application
This application is for applicants that are older than 18 years old.
Name *
First Last
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Home Address *
Your answer
Email *
Your answer
Phone number *
Your answer
Driver's License Number *
Your answer
Occupation
Your answer
Previously Applied? *
Have you ever applied to be a member of RRS before?
If so, approximately when?
Your answer
Experience *
Have you ever belonged to a fire or EMS agency? If so, please list the unit and membership dates.
Your answer
EMS training
Please list any current EMS training that you have.(ie. EMT, CPR, First Aid, First Responder...)
Your answer
Other
Please list any other skills that you have that might be beneficial to the squad
Your answer
Reason for Joining *
Why do you want to join the Randolph Rescue Squad?
Your answer
Convictions? *
Have you ever had a felony conviction or DUI? If so please give dates and offense.
Your answer
Certifications?
Are you currently prevented from obtaining any EMS certifications? If so give reasons why.
Your answer
Expectations *
All members are required to ride one evening shift, Sun - Fri, and one 36 hour weekend shift every other month. Do you have any limitations in meeting these requirements? If so list them here.
Your answer
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