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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


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

    Emergency Service Experience

    Driving Record


    Criminal Records




    AHAARCNational Safety

    Driving: CEVOEVOC



    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