Name: Birth Date: Address: Phone: E-Mail: Employer or School: Business Phone: CPR, First Aid or other Medical Training: Name of Course Date Completed Location/Organization References: Please list 2 character references other than relatives Name Mailing Address Phone Number Have you been a member of any other First Aid, Rescue or Fire organizations? Yes No If yes, please include name of squad/department, dates of membership, and reason for leaving. Squad or Department Dates of Membership Reason for Leaving What type of membership are you applying for? Active (responding to ambulance calls) Affiliate (assisting with administrative and other non-emergency functions If intereted in Active membership, when are you available for duty? Sun. Mon. Tues. Wed. Thur. Fri. Sat. Days: Evenings: If interested in Affiliate Membership, in which areas would you like to work? Fund Raising Publicity Building & grounds Administration Computer/office technology Other By clicking on the Submit Application button below, you certify that all of the information is correct. This application will be reviewed by the Personnel Committee of the Summit First Aid Squad. If you do not receive a response from us within 2 weeks, please contact the Squad building at (908) 277-9479. You may also print this form and mail to: Personnel Officer Summit Volunteer First Aid Squad P.O. Box 234 Summit, NJ 07902-0234 Thank You!
CPR, First Aid or other Medical Training:
References: Please list 2 character references other than relatives
Have you been a member of any other First Aid, Rescue or Fire organizations? Yes No If yes, please include name of squad/department, dates of membership, and reason for leaving.
What type of membership are you applying for?
Active (responding to ambulance calls) Affiliate (assisting with administrative and other non-emergency functions
If intereted in Active membership, when are you available for duty?
If interested in Affiliate Membership, in which areas would you like to work?
Fund Raising Publicity Building & grounds Administration Computer/office technology Other
By clicking on the Submit Application button below, you certify that all of the information is correct. This application will be reviewed by the Personnel Committee of the Summit First Aid Squad. If you do not receive a response from us within 2 weeks, please contact the Squad building at (908) 277-9479. You may also print this form and mail to: Personnel Officer Summit Volunteer First Aid Squad P.O. Box 234 Summit, NJ 07902-0234