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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