EMS Only Application
First and Last Name *
Address *
Phone Number *
Email Address *
Are You a Certified EMT? *
Required
Are You able to life 150+ Lbs. *
Required
Willing to take a NYS Emt class if not certified? *
Required
Ever been a member of another emergency services agency? *
Required
If So Please Provide Which agency(name, address, Chief Name and contact.) *
References
List Three Personal References non-relative and not a member of this organization.
Reference 1 *
Reference 2 *
Reference 3
Within the Freedom of information law, all information contained/or obtained herein will remain confidential and will be used only for internal membership processing. Applications may also be reviewed by the Fire Board of Fire Commissioners.
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