Manorville Ambulance – Adult Application

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SUFFOLKS BRAVEST | SUFFOLK COUNTY REMSCO

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Before you start please read:

Application
References
Volunteer Profile
Background Check

Order Number

First Name *

Middle Initial

Last Name *

Address *

Phone Number

Email Address

DOB *

Do you have a valid N.Y.S Drivers License? *

Yes

License Number

Has your Drivers license ever been revoked or suspended?

Yes

Have you ever been convicted of a misdemeanor, felony or serious infraction of the law?

Yes

If Yes, Please explain

If so, have you completed all the conditions of your sentence?

Yes

Have you ever been convicted of operation of amotor vehicle while impaired by Alcohol or drugs?

Yes

If Yes, Please explain

If so, have you completed all the conditions of your sentence?

Yes

Who were you referred by?

Have you ever been a member of another Ambulance Corps or Fire Dept?

Yes

If yes, what Corps/Department?

Do you have any Medical Training?

Yes

If yes, list type, certification # and expiration date

List pertinent Schooling and work experiences

List any other skills or qualifications which you feel would qualify you for membership

When are you available to serve? (List Days & Hours)

Reference 1 Full Name *

Address *

Phone Number *

Email Address *

Reference 2 Full Name *

Address *

Phone Number *

Email Address *

Reference 3 Full Name *

Address *

Phone Number *

Email Address *

Your name

Home Address

Town/State/Zip Code

Home Phone

Date of Birth

E-Mail

Name of Employer

Business Address

City/State/Zip Code

Business Phone

I prefer to be contacted at

Home

Business

Education

High School

Some College

College Graduate

Graduate Studies

Previous Experiences

Fire

EMS

Rescue

Medical

Other

Reason for Volunteering

Department Member referred

TV/Radio Ads

Website

Newspaper Ads

Family Member

Friend

Other (fill out below)

Other Reason for Volunteering

Background Check

Please make sure that you download the background check and take it with you for the interview.

The form must be signed by a notary

Please also bring a copy of your license.

Background Check PDF File

Introduction

Dear Prospective Member,

Welcome to Manorville Community Ambulance! You have taken the first step in being a valuable person to the Manorville, Manor Park or Calverton Community. On behalf of our membership and our community we would like to thank you for inquiring about membership to our department

Volunteering is not a task that most individuals like to puruse. In the Emergency Medical services, we are a branch that deals with life and death on an everyday basis. We hope that your interest transcends the pihosophy that helping those in need is what we are here for. We are always looking for new members who want to take on this responsibility

In order to be considered for membership, you must fill out the enclosed application. Please read the requirements as written by the State and County Officials regarding qualifications for being a volunteer in EMS.
Please return the application so that we can process it in a timely manner.

We hope this letter informs and increases your interest in our beloved field, and wish you the best of luck.

Sincerely,

The Membership Committee

Probationary Member Requirements

A Review period is 4 months. Probation for a new Member is 6 months. Probationary Members must complete the following.

- Attend ALL Monthly Membership meetings during Probationary (1st Tuesday) Period
- Attend ALL trainings during probationary Period (3rd Tuesday)
- Attend OSHA Training and HazMat Operation Training HazMat Operations Training
- Serve one (1) 4 hour Duty Crew per week during the following hours:
- > 1800 hrs - 0600 hrs Weekdays and/or
- > 1800 hrs - 0600 hrs Friday - Monday

The total number of Duty Crews that need to be completed in the 6 month Probationary period is 24 Duty Crews.
Additional Duty Crews such as STand-Bys, trainings, and/or special events are excluded from the above requirements unless approved by the Company Officers.

Any exceptions to these rules are to be approved by the officers of Manorville Community Ambulance and will be reviewed every 6 months.

You will also be required to have a drug screening and Hepatitis B shots. Dr. Celantano is used by Manorville Community Ambulance free of charge or you may use your own doctor, at your expense.

Member Requirements (after probation)

Maintain a minimum of eighteen (18) points for each four (4) month review period

- Attend two (2) Trainings in the review period
- Serve sixteen (16) 4 hour Duty Crew during the following hours:
> 1800 hrs - 0600 hrs Weekdays and/or
> 1800 hrs - 0600 hrs Friday - Monday

Additional Duty Crews such as STand-Bys, trainings, and/or special events are excluded from the above requirements unless approved by the Company Officers.

Any exceptions to these rules are to be approved by the officers of Manorville Community Ambulance and will be reviewed every 6 months.

You will be required to have OSHA training 1x/year and complete a ONE time HazMat Operations training. Minimum requirements of CPR/1st Aid must be maintained. See the Training Officer if you have any questions regarding these trainings.

Member: National Safety Council - New York State Volunteer Ambulance & Rescue Association, Inc

P: (631) 878-6333
Manorville Community Ambulance
Headquarters
184 South Street
Manorville, NY 11949

Manorville Community Ambulance is a non-profit, volunteer organization whose purpose is to serve the emergency medical needs of the residents of the Manorville Ambulance tax district in Manorville, South Manor, Calverton and Mastic, New York since 1974.

VOLUNTEER TODAY!

Home
About Us
- History
- Apparatus Gallery
Leadership
Membership
..Other
- Contact Us
- PCR Requests