Harpur's Ferry Fall 2018 Membership Application
Thank you for applying to become a member of Harpur's Ferry SVAS. Please fill out the application below prior to the Fall GIM. The GIM will be held on August 28th at 9PM in the Mandela Room in the Old University Union.

If you have any questions or concerns about the application or the GIM date, please email Seth at personnel@harpursferry.org

First Name *
Your answer
Last Name *
Your answer
Email address *
Your answer
Phone Number *
Your answer
What is your anticipated graduation date? *
Required
What is your major? *
Your answer
Harpur's Ferry requires a valid US Driver's License or EMT certification. Please provide the state of your license as well as the license number. *
Your answer
How many times have you applied to Harpur's Ferry? *
Do you have any EMS experience? *
Are you EMT certified? *
Please list any certifications you currently hold below and include why you chose to get the certification. *
Your answer
Do you have any experience in healthcare that is unrelated to EMS? *
Your answer
Please list any additional work or volunteer experiences below. *
Your answer
How do you go about achieving goals? *
Your answer
How do you manage your time? *
Your answer
How do you handle stress? *
Your answer
Which "leadership qualities" are your strongest? Which are your weakest? *
Your answer
Why did you chose to apply to Harpur's Ferry? *
Your answer
What do you hope to gain from joining Harpur's Ferry? *
Your answer
Listed below are roles within Harpur's Ferry.
Driver: A Harpur's Ferry Driver responds to the scene with one of Harpurs Ferry's vehicles. Driver's are trained to drive both the Ambulance and Flycars. A driver is in charge of all radio communications with dispatch. Does this position interest you? If so, why? *
Your answer
Crew Chief: A Harpur's Ferry Crew Chief is in charge of all aspects of patient care. A Crew Chief is in charge of delegating responsibilities to other crew members. Crew Chiefs report the status of the incoming patient to the hospital via radio. Does this position interest you? If so, why? *
Your answer
Trainee: A trainee is a certified EMT who assists in the care of the patient. Trainees help complete aspects of patient care as delegated to them by the Crew Chief. Does this position interest you? If so, why? *
Your answer
Preceptor: A preceptor is a Driver or Crew Chief with significant experience. Preceptors train other members to become Drivers or Crew Chiefs. Does this position interest you? If so, why? *
Your answer
Staff Officer: Each staff officer plays an administrative role within the agency. Staff Officers are voted in through a vote by the General Membership. If this interests you, please go to harpursferry.org to find out more about the roles of each staff officer. Do any of the staff positions interest you? If so, why? *
Your answer
Harpur's Ferry's GIM is August 28th at 9 PM in the Mandela Room and it is mandatory for applicants to attend. If you are unable to attend, please email Seth at personnel@harpursferry.org. Will you be attending? *
Submit
Never submit passwords through Google Forms.
This form was created inside of Harpur's Ferry Student Volunteer Ambulance Service. Report Abuse - Terms of Service