Thank you for your interestPlease fill out the below application and an Officer will contact you.**Paid staff positions are expected to have 6-12 months of primary 911 response experience** Position of Interest * Volunteer EMT-Basic Volunteer Driver Volunteer Aide Volunteer Junior Member Volunteer Non-Riding Member Not Sure Paid Staff Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth * MM DD YYYY Email 1 * Phone * (###) ### #### Name of Emergency Contact * First Name Last Name Phone Number of Emergency Contact (###) ### #### Do you have a current driver's license? * Yes No Driver's License State: Driver's License Class: Driver's License CID Number: What is your current occupation? Do you have any of the below certifications? * (Check all that apply) NYS EMT-B NREMT AHA CPR OSHA Bloodborne Pathogens CEVO EVOC None If you have a current NYS DOH certification please provide the certification number and expiry date: Please format replies: Certification Number, Expiry Are you a member of or employed by an Emergency Service? (Fire / Police / EMS) * Yes No If Yes, please provide the following information: Service Name, Years of Service, Address and Phone Number of Service Do you have any other medical training? * Yes No If yes, what training? Why are you interested in joining the Dobbs Ferry Volunteer Ambulance Corps? * Please provide 3 references - two personal and one professional Personal Reference #1 * First Name Last Name Personal Reference #1 Phone Number * (###) ### #### Personal Reference #1 Email * Personal Reference #2 * Personal Reference #2 Email * Personal Reference #2 Phone Number * (###) ### #### Personal Reference #3 * Personal Reference #3 Email * Personal Reference #2 Phone Number * (###) ### #### Have you ever been convicted of any crimes? Violations, Misdemeanors, Felonies, Traffic Summons? Yes No If Yes, please supply the following information: Summons, Date of Issuance, Location of Occurrence, Out Come (Guilty/Not Guilty/No Contest) BY SUBMITTING THIS APPLICATION THE APPLICANT AUTHORIZES THE DOBBS FERRY VOLUNTEER AMBULANCE CORPS, INC. TO VERIFY ALL INFORMATION SUBMITTED. VERIFICATION MAY INCLUDE A REVIEW OF ALL CRIMINAL AND MOTOR VEHICLE RECORDS. THE APPLICANT AGREES TO ABIDE BY THE DOBBS FERRY VOLUNTEER AMBULANCE CORPS, INC. BY-LAWS AND STANDARD OPERATING PROCEDURES ONCE BECOMING A MEMBER. FAILURE TO ABIDE BY THESE RULES MAY RESULT IN A DENIAL OF MEMBERSHIP OR EXPULSION. Submission of this application does not guarantee membership. Thank you for your application!An officer will be in touch with you shortly.
