Volunteer Membership Application
Please fill this form out if you are interested in becoming a volunteer member of Exchange Ambulance of the Islips. Once completed, you will hear back from our membership committee about the next steps in the interview process. Those steps will include a new member meeting, background check, drug screening and physical by our department physician.
Name *
Your answer
Phone Number *
Your answer
E-mail Address *
Your answer
Street Address
Your answer
City *
Your answer
Type of Membership Desired
Are you AHA BLS Provider certified?
Do you hold a NYS EMT certification?
Do you have previous EMS/medical experience?
If so, what?
Your answer
Have you belonged to another Fire or EMS agency before?
If so, where?
Your answer
What is your availability? Please keep in mind we require each of our members to commit to 6 hours of duty each week after the initial training period. We are a 24/7 emergency service and we have crews scheduled around the clock 365 days a year. (Select All That Apply)
12am to 6am
6am to 12pm
12pm to 6pm
6pm to 12am
Are you available either Sunday night or Wednesday night for training for the the first 6 months of membership? *
Your answer
Why do you wish to join the Exchange Ambulance of the Islips? *
Your answer
Riding Members Only: Are you looking to become an EMT and/or drive the ambulance? Please keep in mind that all of our riding members are required to complete an EMT certification course (if not already done so) or become a cleared ambulance driver within the first two years of membership.
Comments and/or Questions:
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.