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Seymour Ambulance Association Inc.

4 Wakeley St. Seymour, CT 06483

Volunteer Membership Application


Personal Information








Military Service

ArmyNavyMarinesAir ForceCoast Guard



Work Experience











Education

Highest Level of Education: Attending High School H.S. Diploma Associate Degree Bachelor Degree GED





Emergency Service Experience














Driving Record




YesNo



Criminal Records


YesNo



Certifications


EMREMTAEMTParamedic



AHAARCNational Safety


Driving: CEVOEVOC



Availability
From







To:







Our shifts are in 6hr blocks and run 6a-noon, noon-6p, 6p-midnight, and midnight-6a.

I agree that all the information provided in the application above is true and accurate. I understand that if any information was falsified my application will be removed from consideration and I will not be able to reapply within a period of 90 days from the date below.









Criminal Record Check Form

Freely authorize Seymour Ambulance Association Inc. to have a criminal, motor vehicle, and if necessary credit check done and authorize information to be released to them. I also agree to furnish a copy of my DD 214 form if requested.




Arrest Record Information