Fire and EMS Recruitment Form

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Please complete this form if you are interested in volunteering for a Fire or EMS service. We will forward your request to the closest appropriate department.

Name *

Home Address *

What town, village, or hamlet do you live in? *

Wayland, Village

Wayland, Town

Springwater

Perkinsville

Cohocton, Village

Cohocton, Town

Dansville, Village

Atlanta or North Cohocton

Are you interested in volunteering for a Fire Department or EMS agency? *

Fire Department

Fire Department with EMS First Response

EMS Transporting Agency

Both Fire and EMS

Do you have any Fire or EMS experience?

Firefighting

Emergency Vehicle Operator (EVOC, CEVO, etc)

Emergency Medical Technician

EMT - Paramedic

How would you like to help a Fire Department or EMS Agency?

First Responder

Teaching

Becoming a Junior Member

Administrative Help

Fundraising

Other:

Best Phone number to be reached at *

Best time to call?

Weekday daytime (between 9 AM and 5 PM)

Weekday Evening (between 5 PM and 9 PM)

Weekend daytime (between 9 AM and 5 PM)

Weekend Evening (between 5 PM and 9 PM)

Clear selection

Any comments or questions?

Submit

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