membership application

advertisement

Part I: Pre-Interview Application

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? _________________

Part II: Personal Statement

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?

Part III: Photo Identification

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.

Download