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VOLUNTEERING with NREMS

Welcome to the Northampton Regional EMS Volunteer section.  Volunteer applications are welcome at all times.  As you may well imagine, a variety of different functions are accomplished by our volunteer members.  Some of these functions and positions incluce administrative and secretarial work, housekeeping, First Responders, Emergency Medical Technicians (EMTs), Paramedics, and Health Professionals.

Below is an application that you can print, complete, and submit to NREMS. If you have access to Microsoft Excel version 4 or higher (Office 4.0, Windows 95 or Office 97) or any compatible program, you may click on the link below and download the form. After it is completed, you can either return it via EMAIL, in person, or via US Mail to the above address. If you have any questions, please contact us.

You can also download the Microsoft Excel Viewer (Windows 95/98/NT), install it on your computer, and read/print the application.  See our Utilities page.

NREMS JOB DESCRIPTIONS

NREMS Application (Excel 4.0 or higher)

NORTHAMPTON REGIONAL

EMERGENCY MEDICAL SERVICES

1525 CANAL STREET
NORTHAMPTON, PENNSYLVANIA 18067


EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER

THE NORTHAMPTON REGIONAL EMERGENCY MEDICAL SERVICES RECOGNIZES THAT ALL PERSONS ARE ENTITLED TO EQUAL EMPLOYMENT OPPORTUNITIES, AND IN IT'S RECRUITMENT, TRAINING AND COMPENSATION PRACTICES, THE BEST QUALIFIED INDIVIDUAL, BASED ON ORGANIZATIONAL REQUIREMENTS, SHALL BE SELECTED, WITHOUT REGARD TO RACE, COLOR, SEX, OR NATIONAL ORIGIN AS WELL AS MENTAL AND PHYSICAL HANDICAPS THAT DO NOT INTERFERE WITH JOB PERFORMANCE.

DATE OF APPLICATION REQUEST:_______________________ POSITION APPLIED FOR:_______________________


PERSONAL INFORMATION

NAME: _______________________________________________ PHONE #: ___________________________________

ADDRESS: _________________________________________________________________________________________

COUNTY OF RESIDENCE: _______________________________ SOCIAL SECUTITY #: __________________________

UNITED STATES CITIZEN : _______________________________ ALIEN # IF NO : _______________________________

PERSON WHO REFFERED YOU TO NREMS: ____________________________________________________________

HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR: YES / NO

IF YES PLEASE EXPLAIN: ____________________________________________________________________________

A CONVICTION RECORD WILL NOT NECESSARILY BE A BAR TO MEMBERSHIP OR EMPLOYMENT. FACTORS SUCH AS AGE AND TIME OF OFFENSE, SERIOUSNESS, AND NATURE OF VIOLATION AND REHABILITATION WILL BE TAKEN INTO ACCOUNT.

SALARIED POSITIONS ONLY:

WHAT DATE CAN YOU BEGIN WORK :_____________________

HOW MUCH NOTIFICATION WILL YOU REQUIRE :____________________

WILL YOU ACCEPT PART TIME WORK :____________________________

IN THE EVENT OF AN EMERGENCY PLEASE NOTIFY:

NAME: _______________________________________________ PHONE :_____________________________________

ADDRESS:__________________________________________________________________________________________


 

TRAINING INFORMATION

COURSE TITLE

EXP. DATE

STATE

CERTIFICATION #

 


EDUCATION:

HIGH SCHOOL: _________________________________________ DATE GRADUATED :__________________________

BUSINESS SCHOOL : ____________________________________ DATE GRADUATED :__________________________

COLLEGE : ____________________________________________ DATE GRADUATED :__________________________

MAJOR : _______________________________________________ DEGREE : __________________________________

OTHER : ___________________________________________________________________________________________


MILITARY:

DATE OF ACTIVE STATUS : FROM: _______________ TO: __________________

BRANCH OF SERVICE: ___________________________ INDUCTION RANK:_______________________

SEPERATION RANK:_____________________________ CURRENT AFFILIATION: ______________________________

MILITARY SPECIALIZATION : __________________________________________________________________________


EMERGENCY SERVICES AFFILIATION

INCLUDE SEVICE NAME AND YOUR INVOLVEMENT WITH THAT SERVICE

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

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REFERENCES

NAME : _____________________________________ OCCUPATION : _________________________________________

ADDRESS : ____________________________________________________________YEARS KNOWN : _____________

TELEPHONE NUMBER : ___________________________________

NAME : _____________________________________ OCCUPATION : _________________________________________

ADDRESS : ____________________________________________________________YEARS KNOWN : _____________

TELEPHONE NUMBER : ___________________________________

NAME : _____________________________________ OCCUPATION : _________________________________________

ADDRESS : ____________________________________________________________YEARS KNOWN : _____________

TELEPHONE NUMBER : ___________________________________


EMPLOYMENT HISTORY

EMPLOYER NAME : _________________________________________________________________________________

ADDRESS : ________________________________________________________________________________________

TELEPHONE : __________________________________ DATES OF EMPLOYMENT : ___________________________

TITLE : ________________________________________ SUPERVISOR : ______________________________________

YOUR RESPONSIBILITIES : ___________________________________________________________________________

REASON FOR LEAVING : _____________________________________________________________________________

MAY WE CONTACT : _______________________________________________________________________________

EMPLOYER NAME : _________________________________________________________________________________

ADDRESS : ________________________________________________________________________________________

TELEPHONE : __________________________________ DATES OF EMPLOYMENT : ___________________________

TITLE : ________________________________________ SUPERVISOR : ______________________________________

YOUR RESPONSIBILITIES : ___________________________________________________________________________

REASON FOR LEAVING : _____________________________________________________________________________

MAY WE CONTACT : _______________________________________________________________________________

 

EMPLOYER NAME : _________________________________________________________________________________

ADDRESS : ________________________________________________________________________________________

TELEPHONE : __________________________________ DATES OF EMPLOYMENT : ___________________________

TITLE : ________________________________________ SUPERVISOR : ______________________________________

YOUR RESPONSIBILITIES : ___________________________________________________________________________

REASON FOR LEAVING : _____________________________________________________________________________

MAY WE CONTACT : _______________________________________________________________________________

EMPLOYER NAME : _________________________________________________________________________________

ADDRESS : ________________________________________________________________________________________

TELEPHONE : __________________________________ DATES OF EMPLOYMENT : ___________________________

TITLE : ________________________________________ SUPERVISOR : ______________________________________

YOUR RESPONSIBILITIES : ___________________________________________________________________________

REASON FOR LEAVING : _____________________________________________________________________________

MAY WE CONTACT : _______________________________________________________________________________


OTHER INFORMATION

PLEASE LIST ANY OTHER QUALIFICATION, SKILLS OR EXPERIENCES WHICH YOU FEEL WOULD RELATE TO YOUR MEMBERSHIP OR EMPLOYMENT WITH THE NREMS:

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

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___________________________________________________________________________________________________

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OTHER STATEMENTS

I CERTIFY THAT ALL THE INFORMATION ON THIS APPLICATION IS TRUE AND ACCURATE. I UNDERSTAND THAT WILL BE CAREFULLY CHECKED AND THAT MISREPRESENTATION OR OMISSIONS OF FACTS ON MY PART MAY BE JUSTIFICATION FOR SEPARATION FROM THE ORGANIZATIONS SERVICES, IF EMPLOYED OR ACCEPTED INTO MEMBERSHIP. I AUTHORIZE THE NREMS OR MY FORMER EMPLOYERS OR REFERENCES TO FURNISH ANY INFORMATION CONCERNING MY PERSONAL BACKGROUND CHECK OR EMPLOYMENT RECORDS AND I HEREBY RELEASE ALL SUCH PERSON'S FROM ANY LIABILITY ON ACCOUNT OF HAVING FURNISHED THIS INFORMATION. I UNDERSTAND THAT IF EMPLOYMENT IS OBTAINED UNDER THIS APPLICATION, THE ORGANIZATION DOES NOT GUARANTEE EMPLOYMENT FOR A FIXED TERM. FINALLY, I HEREBY AGREE TO SUBMIT TO A PHYSICAL EXAMINATION IF REQUESTED BY THE NREMS AND I ATTEST TO THE FACT THAT I AM NOW PHYSICALLY CAPABLE OF PERFORMING ALL RESPONSIBILITIES WITHIN THE SCOPE OF THE POSITION FOR WHICH I APPLIED.

SIGNATURE DATE

DATE OF BIRTH : _____________________________ STATUS : ___________________________________________

DATE OF HIRE / ACCEPTANCE : __________________________________

 

Northampton Regional Emergency Medical Services, Inc. is an equal opportunity employer.

 


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Last modified: June 03, 2000