Application for Membership to the Pennington First Aid Squad






State:

Driver's license state   If you do not find the agency that issued your license in the drop-down list, enter the agency and number in the "any comments" box below.

Relevant Medical Experience





Other Background Information

Have you ever been convicted of a crime?       

Have you been vaccinated for Hepatitis B?        If yes, be prepared to supply proof.

You must read the job description of an EMT or you will not be able to submit this form. Are there any physical or mental reasons why you might be unable to perform patient care as an EMT? Examples might be lifting at least 125 lb, squatting, kneeling, hearing, vision.

Please give us three references we can call. References must not be relatives.



Ride requirements for applicants who do not already have an EMT. Applicants who do not already have an EMT must ride 2.5% of our calls as an observer within their first six months of membership or we will not fund their EMT training. This typically requires two nights per week for applicants who only ride nights, one night per week plus one 12 hour shift on a Sunday every six weeks, or 6 hours per week 6AM to 6PM. Alternatively, applicants who do not already have an EMT may deposit $1200 with PFAS to be repaid by riding after they complete the EMT course.

List the days of the week and times you can ride on each of those days, for example, Mon-Thur all night, Fri 6AM-4PM or indicate that you will make a deposit.

Enter any comments you think might be relevant to this application

How did you find out about the Pennington First Aid Squad

I will consent to a criminal background check. Minors will not be asked.