Lambertville - New Hope Ambulance & Rescue Squad Online Application
Email address
Legal First and Last Name
Your answer
Address (Please No PO boxes)
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Phone Number (XXX)XXX-XXXX
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Date of Birth
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Membership Category
Are you authorized to work in the U.S.?
Are you now or have you ever been a member of other emergency services?
Please list any below, including start and finished date.
Your answer
Have you ever been arrested?
If yes, please explain in other
Have you ever been convicted of a felony?
Do you have a driver's license?
If yes, please list state and number in other
Is your driving privilege revoked in any state?
What is your highest level of education?
Your answer
Please list any emergency services training that you have completed.
Your answer
Reference 1 Name and Relation
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Reference 1 Phone Number (XXX)XXX-XXXX
Your answer
Reference 2 Name and Relation
Your answer
Reference 2 Phone Number (XXX)XXX-XXXX
Your answer
Reference 3 Name and Relation
Your answer
Reference 3 Phone Number (XXX)XXX-XXXX
Your answer
Employment History
Please list last 3 employers, including Name, phone number, job title, supervisor and reason for leaving.
Your answer
Have you ever been in the military?
Please list Branch, years of service, rank at discharge and type of discharge.
Your answer
I certify that my answers are true and complete to the best of my knowledge. I understand that false or misleading information in my application or interview may result in my rejection or dismissal. I agree to comply with all orders, rules, regulations. policies, SOP’s, and by-laws of this squad. I further agree that I am physically and mentally qualified for membership as described in the “Qualifications for an Ambulance Attendant” (if applicable) provided with thisapplication. I agree to submit to a physical examination by a licensed physician approved by the Squad. I agree to submit to a background check administered by the Police Department or agency designated by the Lambertville New Hope Ambulance & Rescue Squad. Please type your name below as a digital signature to this statement.
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