Name: ________________________ Email: ____________________________ Phone: (___) ___-____
Graduation Month/Year: ________________ Major: _________________________
Do you have a US Driver’s License? Yes No
List any previous volunteer or employment experience: _______________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Circle highest NYS certification: None CFR EMT-B EMT-I EMT-CC EMT-P
CPR Certified? Yes No
List any non-NYS EMS certifications: ____________________________________________________
Describe any prior experience with EMS: ________________________________________________
_______________________________________________________________________________________________
What questions do you have about Harpur’s Ferry? ____________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
How many times have you applied to Harpur’s Ferry before? _________________________
What is your greatest strength? ___________ Greatest Weakness? _________________

In 250 words or less, why are you interested in EMS? What unique personal attribute do you believe will help you succeed in emergency medicine?
Please attach a photo of yourself to the Pre-Interview Application and Personal
Statement.
*Note: In order to sign up for an interview, you must have all three (3) parts completed and attached. This application packet will be handed in at GIM prior to interview scheduling.