Volunteer Emergency Medical Technician (NYS EMT)

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A resume is required
The file attachment is limited to 50MB

Personal Details

Full Name*

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Email Address*

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Phone Number*

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Address

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Experience

Education*

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  • Is this your first time applying to volunteer with CPMU*

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  • Address*

    Please provide your current address.

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  • City*

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  • State*

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  • Zip*

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  • Are you over eighteen years of age?*

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  • Driver License*

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  • New York State EMT Certification*

    Unless you are a non-EMT applicant, with previous emergency vehicle operation experience, you MUST upload a copy of your NYS EMT Certification here. EMT certification MUST be from New York State (not out of state or National Registry).

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  • CPR Certification*

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  • Have you served on an ambulance before as either a certified EMT or as an ambulance driver?*

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  • If you answered "yes" above, please share with us--briefly--your experience.*

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  • What is your EMT certification level?*

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  • Why are you applying to volunteer with the Central Park Medical Unit?*

    This is an important question for you and for us. Please treat your answer to this question as a cover letter / personal statement, but more concise. At least two (2) paragraphs is preferred to give us a sense of your interest in CPMU. We want to know why you are interested in volunteering specifically with CPMU.

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  • How did you learn about CPMU?*

    If you were referred to CPMU by a current member, please type that member's full name below.

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  • We operate primarily on weekends, beginning sharply at 9:00 AM and completing at least seven hours per tour. Saturdays and Sundays are when we'd need you the most. During the summer, the frequency of which we would need you may increase. Realistically, how many weekend tours would you be able to commit to serving per month?*

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  • What, if anything, concerns you about making a commitment to volunteer on weekends and/or volunteer with CPMU for a minimum of 18 months?*

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  • Why did you become an EMT?*

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  • Have you ever been denied membership and/or employment by CPMU or any ambulance, fire, medical, emergency service, health care or rescue organization?*

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  • If you answered, "YES" above, why were you denied membership and/or employment by CPMU or any ambulance, fire, medical, emergency service, health care or rescue organization?*

    Please explain your answer and provide as much information as possible.

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  • Have you ever been disciplined by any ambulance, fire, medical, emergency service, health care or rescue organization while in service as a health care or pre-hospital emergency service provider?*

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  • If you answered, "YES", above, why were you disciplined by any ambulance, fire, medical, emergency service, health care or rescue organization while in service as a health care or pre-hospital emergency service provider? What was the nature of that discipline?*

    Please explain your answer and describe what disciplinary action was taken and why it was taken.

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  • Have you ever had a driver's license that was issued to you suspended or revoked?*

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  • If you answered, "YES", above, why was your driver's licenses suspended or revoked?*

    Please list all violations or occurrences that led to your license being suspended, including dates.

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  • Have you been convicted of a felony or misdemeanor as an adult?*

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  • If you answered, "YES", above, with what crime(s) were you charged? What was the final disposition for any charges?*

    Please be as detailed as possible.

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  • Do you have any impairment, physical, mental, or medical that would interfere with your ability to work on an ambulance or with patients in an emergency situation?*

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  • If you answered, "YES", above, what physical, mental, and/or medical impairment would interfere with your ability to work on an ambulance or with patients in an emergency situation?*

    Please be as detailed as possible.

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  • Reference Check*

    Please enter three references.

    • Reference 1

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      Relationship

      • Professional
      • Personal
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    • Reference 2

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      Relationship

      • Professional
      • Personal
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    • Reference 3

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      Relationship

      • Professional
      • Personal
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  • Reference 1 Phone*

    Example: (212) 555-0000

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  • Reference 2 Phone*

    Example: (212) 555-0000

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  • Reference 3 Phone*

    Example: (212) 555-0000

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  • TERMS & CONDITIONS*

    In consideration of my application I authorize Central Park Medical Unit to make investigations concerning my fitness for volunteerism; to seek information about me from the references and employers contained in this application or any documents submitted by me; to investigate my employment history; and to make investigations concerning any oral or written information obtained about me during the consideration process. I authorize the references, educational institutions and employers listed on this application to give Central Park Medical Unit any and all information concerning my education and employment and pertinent information they may have, personal or otherwise, including the names of additional references which Central Park Medical Unit may contact.

    I release all parties from any and all liability for any damage that may result from furnishing this information concerning me to Central Park Medical Unit. I understand that this authorization includes: any communications with me, my references, former employers, educational institutions, or additional references furnished by my references or former employers; and investigations concerning information contained in cover letters, resumes, writing samples, letters of recommendation, placement office files, student records, and any other documents received.

    I agree that all materials received by Central Park Medical Unit become the property of Central Park Medical Unit. I certify that the information contained in this application is true and complete to the best of my knowledge and understand that omission or misrepresentation of any facts is grounds for denial of employment or volunteerism, or, dismissal if hired or approved to volunteer. I understand that the information I have presented in my resumé may be verified, including dates of employment, titles, degrees, etc.

    I also understand that I will be asked to sign a release authorizing a background check. Background checks are done as a matter of course for all volunteers.

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  • AFFIRMATION*

    I affirm that the statements and answers provided by me in this Volunteer Ambulance Service Application and/or otherwise provided by me to Central Park Medical Unit (CPMU) (e.g., my resume) in connection with my application for volunteerism with the Central Park Medical Unit are completely true, correct, and complete.

    I also understand that CPMU’s review of this application is not an express or implied guarantee of volunteerism with CPMU.

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  • Electronic Signature*

    Please type your FULL NAME below, acknowledging that you have read and accepted our Terms and Conditions and Affirmation.

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  • NOTE:*

    Please ensure that you have completed all "required" questions and uploaded all "required" documents. If you click "Submit Application" and nothing happens, you may need to scroll up to determine where the errors are in your application.

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