West End Volunteer Rescue Squad Online Membership Application

Please make sure you have access to a printer before continuing with the application. Fields marked with an asterik are required.

Personal Information

*Last Name
* First Name
Middle Name
* Social Security Number	- -
* Street Address
Street Address continued
* City
* State
* Zip Code
* Primary Phone	- -
Secondary Phone	- -
* E-mail Address

Desired Membership Classification

*Select the type of membership desired with West End Volunteer Rescue Squad. Please check only one box.

	Active Membership is open to any person who is an Emergency Medical Technician-Basic or higher or any person desiring such training. Training at the EMT-Basic level is usually provided free of charge to West End Members. Active members staff ambulances and are assigned to a specific "crew." They must pull at least 48 hours a month of duty. Active members are also expected to participate in BINGO, the squad’s main fundraiser at least once a month.
	Associate Membership is open to any individual who is a cleared provider (EMT-B and above) at another agency (Volunteer or paid, Fire/EMS or EMS). Associate members do not have voting privileges, cannot hold offices, and have less duty requirements than Active Membership.
	Support Services is open to persons that can assist the squad but do not desire to staff an ambulance and run emergency medical calls. No special skills or talents required, just a desire to assist. Can you answer a phone, cook a meal, type letters? Want to help the squad raise money? We could definitely use your help!

Membership Process

Thank you for your interest in becoming a member at West End Volunteer Rescue Squad. To ensure that we make a decision that is right for both you and the squad, we use a number of different selection tools and consider different types of information before a decision is made. As you go through the member selection process, you may come in contact with some or all of the following selection tools.

Membership Application – Complete all sections which pertain to you and sign / date the application. The application allows West End Volunteer Rescue Squad to determine your qualifications and experience. By signing the application, you authorize West End Volunteer Rescue Squad to verify the information contained in the application for accuracy. Falsification of information on the application or failure to provide accurate information can result in disqualification for membership or removal of membership if discovered after becoming a member.

Membership Interviews – You will be contacted by a member of the Membership Committee to complete an interview either in person or over the phone. The goal of this phase is to get to know the applicant better and get a feel for what qualifications he or she can bring to the squad.

Squad Membership Meeting – You must attend at least one West End Volunteer Rescue Squad Membership Meeting before being considered as a member. Meetings are held on the first Monday of every month. Food is served at 6 p.m. and the meeting starts promptly at 7 p.m. Interviews are usually conducted after the meeting around 8 p.m.

Reference Checks – Current and former employers, educations, and personal references are verified prior to an offer of membership.

Records Checks – Verification and information checks are performed with criminal courts, state and county repositories of criminal records and the Department of Motor Vehicles.

Loss Prevention Process – The applicant will be questioned concerning the membership application, any current and past involvement with illegal drugs, any prior convictions, and any adverse information from references and other related matters.

Please list all schools or training institutions attended. For each school, include the years attended, course of study, degree received, and GPA.

Please list all paid positions within the last five years. For each position, give the company, your supervisor's name and phone number, your duties and responsibilities, your date of employment, and reason for leaving.

Please tell us a little bit about yourself and why you want to join West End Volunteer Rescue Squad.

*What are your hobbies and interests? Also list any special achievements, awards, or honors.

*Do you have any current certifications? (EMT, Paramedic, Firefighter, Vehicle Extrication, etc..)

*Have you ever been a member at West End Volunteer Rescue Squad or any other volunteer / paid EMS / Fire agency? If yes, list names of agencies and dates involved.

I hereby certify that all of the information contained in the application is complete and accurate to the best of my knowledge. I understand that, if membership is granted, omissions or false or inaccurate statements on this application or the Loss Prevention interview may result in dismissal.

I hereby authorize all current / prior employers, schools, law enforcement agencies and investigative agencies to give West End Volunteer Rescue Squad, Inc. any and all information concerning my current / previous employment and any pertinent information they may have, personal, or otherwise, concerning my potential membership. I release all persons or entities from all liability for any damage that may result from furnishing such information to West End Volunteer Rescue Squad, Inc. I also release West End Volunteer Rescue Squad, Inc. and all of its officers, members, and employees from all liability for any damage that may result from reliance on the information furnished.

If membership with West End Volunteer Rescue Squad is granted, I agree to abide by its policies, rules and regulations. I understand and agree that my membership is at-will, and therefore, my membership can terminate with or without cause at any time, by my option or the option of West End Volunteer Rescue Squad, Inc. This at-will membership may not be modified by any oral or implied agreement.

Typing your full name and date below constitutes your signature and agreement towards the preceeding legal statement.

Please click submit only once. The application process will continue on the next page.