| Full Name : |
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| Date Of Birth (mm/dd/yy)
: |
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| Street Address : |
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| Home Phone : |
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| Work Phone : |
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| Vermont Drivers License # : |
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| Expiration Date : |
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| E-Mail: |
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Prior Rescue/First Aid Training
(include any current
certifications & #???s. Include dates): |
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| Other current service affiliations (fire, rotary, scouts etc.): |
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Why are you interested
in Stowe Rescue: |
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| I am interested in: |
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Do you have any medical limitations
(heart, back problems etc.), which might your ability to perform rescue work (i.e., lifting, bending, carrying)? If yes, please describe condition: |
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Do you have a current
Vermont Driver's License |
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| Have you been convicted of DWI/DUI within the past 5 years? |
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| Have you been convicted of a felony? |
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| Are you willing to take additional training? |
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| What Days and hours are you available to take calls? |
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If living in Stowe less than
6 months list previous address
(and landlord if applicable): |
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| References: |
Please list two personal (not family members) and one professional (work): |
Name |
Address |
Phone |
|
|
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Please ask references listed above to send a written letter of reference to:
Stowe Rescue Squad, PO Box 291, Stowe, VT 05672
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By clicking SUBMIT, I certify that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld no information that, if disclosed, would affect this application unfavorably. I understand that if the Stowe Rescue Squad approves my application, any false statements would be sufficient cause for immediate dismissal.
Stowe Rescue Squad (SRS) is an equal opportunity employer. As a member of SRS you will be expected to act in a professional and courteous manner. You are required to attend one meeting and one training meeting per month. Monthly meetings are held the first Monday of each month, and training is held the third Monday of each month. You are expected to take one 12-hour shift per week of call.
You are responsible for any equipment or uniforms issued to you. Should you resign (or be dismissed) from SRS; all equipment/uniforms must be returned. Any information obtained regarding patient status, condition, history, etc. is confidential. Divulging this information will lead to immediate dismissal. |
