Flemington - Raritan First Aid & Rescue Squad Volunteer Application

Please complete fully, Failure to follow any of the directions may be grounds to not accept this application.

Membership Information
Required Duty Time Per month, minimum of 24 hours

Mandatory Meetings/Drills
Monthly Membership Meeting First Monday of every month at 19:00 (Must Attend 6 Meetings Annually)
EMS Drill Third Monday of every month at 19:00, or day drills instead at times TBD
Rescue Drills Second and fourth Wednesdays of the month
(Must attend 8 out of the 24 Annual Drills)

EMT School
A member must be signed up for EMT school within 12 months of joining

For Junior Members:
Attend 50% of above meetings and mandatory drills and Junior Drills

Applicants should be prepared to start volunteering promptly (within one month) after submitting application. Individuals interested in joining the organization further into the future are encouraged to wait to apply until they are ready to start volunteering.

Email address *

Membership Category *

Standard Adult Member (18+ Years Old)

Junior Member ( 16-18 Years Old)

Associate Member

Supportive Member

First and Last Name (Legal Name) *

Address (Please No PO boxes) *

Please list full address including Street, City, State and Zip Code

How long have you resided at this address? *

Phone Number (XXX)XXX-XXXX *

Date of Birth *

YYYY

How did you hear about us? *

Our Website

Our Facebook Page or Social Media

Google

Member Referral

Other:

Current Member Referral (if applicable)

Please List Member Name

What makes you want to join the Flemington - Raritan First Aid & Rescue Squad? *

What are you goals after joining here? *

What will make you a strong candidate to be a member? *

Where do you see yourself in five years? *

Have you ever been, applied to, or are a current member of any other Emergency Services Department (EMS, Rescue or Fire), paid or volunteer? * *

Yes

If yes, please list all agencies, and the timeframe of which you were involved with each agency.

Please list any emergency services training or certifications that you have or have completed. *

Background Questions

A formal background check will be completed on all applicants during the application process.

What is your highest level of education? *

Do you have a valid driver's license? *

Yes

Drivers license Issuing State

New Jersey

Other:

Clear selection

Drivers License Number

Is your driving privilege revoked in any state? *

Yes

Not Applicable

In connection with my application for membership or employment (including contract for services) with the Flemington - Raritan First Aid & Rescue Squad, I understand that consumer reports and/or criminal background records, which may contain public record information, may be requested and obtained. These reports may include information related to my criminal record and previous driving record including court actions, citations, license suspensions and revocations.I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED TO FURNISH THE ABOVE MENTIONED INFORMATION.I have the right to obtain information as to the name, address and phone number of any agency providing such information and further, may request of that agency, upon proper identification, the nature and substance of all information in its files on me at the time of my request, including all sources of information as well as the recipients of any reports on me which that agency has previously furnished within the two(2) year period preceding my request.This authorization shall remain on file and shall serve as ongoing authorization for the organization to procure criminal background information and Motor Vehicle Reports at any time during my employment, membership or contract period. Please type your name below as a digital signature to this statement. *

Please list Full Legal Name, maiden name or any aliases used. *

References

Professional references are preferred (e.g. employer, teacher, professor, coach, community organization leader, etc.) Individuals listed as references in this section may also be listed in the employment history below.

Reference 1 Name and Relation *

Reference 1 Phone Number (XXX)XXX-XXXX *

Reference 2 Name and Relation *

Reference 2 Phone Number (XXX)XXX-XXXX *

Reference 3 Name and Relation *

Reference 3 Phone Number (XXX)XXX-XXXX *

Employment History

Please list the three most recent if applicable.

Employment History 1 *

Please list last employer, including Name, phone number, job title, supervisor and reason for leaving.

Employment History 2 *

Please list last employer, including Name, phone number, job title, supervisor and reason for leaving.

Employment History 3 *

Please list last employer, including Name, phone number, job title, supervisor and reason for leaving.

Have you ever been in the military? *

Yes

Please list Branch, years of service, rank at discharge and type of discharge. *

Applications Signature

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 this application. 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 Flemington - Raritan First Aid & Rescue Squad. Please type your name below as a digital signature to this statement. *

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