Applicants must fill out and submit the online application listed below. A representative of the Squad will contact you and arrange a meeting with our Membership Committee. For this meeting, applicants should print out and bring a completed hard copy of the Wall Township Police Department APPLICATION FOR EMERGENCY SERVICES IDENTIFICATION CARD.

WALL TOWNSHIP FIRST AID & RESCUE SQUAD
P.O. BOX 1105
WALL, NJ 07719

Federal and State laws prohibit discrimination in membership because of sex, age, race, color, religious creed, marital status, National origin, ancestry, height, weight, liability for service in the Armed Forces of the United States, or other non job-related handicap or disability.

If you do not hear back regarding your online application, please e-mail to webmaster@wallfirstaid.com to confirm that it was successfully delivered by the system.

Application for Membership:

Date of Application:

Type of Application: Active/Associate EMTDriver/TransportNon-EMT Community Member (Administrative and Other Support)

Applicant:

Name:

Present Address Street:

Present Address Town:

Present Address Zip Code:

Primary Phone: Type: HomeCell

Alternate Phone: Type: HomeCell

E-Mail Address:

Date of Birth (DOB):

Age:

Background:

Previous EMS Experience? YesNo

If previous EMS experience, Squad or Private Ambulance Service Name?

If previous EMS experience, Years of Service?

Driver's License Number:

Has your driver's license ever been suspended? YesNo

If your driver's license was suspended, Reason for Suspension?

Have you ever been convicted of an indictable offense or felony crime? YesNo

If yes, please explain:

Attestations:

As a squad member, I will actively support the squad with my due share of time in fund raising activities, obey all rules and regulations as stated in the By-laws, and protect the property of the squad at all times: AgreeDecline

Upon leaving the squad, I will return all squad-owned property in my possession: AgreeDecline

In making application for membership in the Wall Township First Aid & Rescue Squad, I agree to provide to the Wall Township Police Department and/or the Wall Township First Aid & Rescue Squad Membership Committee any and all information, documentary or otherwise, as may be required for consideration of my application: AgreeDecline

The Wall Township First Aid & Rescue Squad reserves the right to reject or accept this application without giving reasons: I understand and agree with this condition of application.

Parent/Guardian Approval:

If the applicant is under the age of 18 years old, a parent or guardian approval is required.

Parent/Guardian Name and Relationship:

Parent/Guardian Statement: As this applicant’s parent/legal guardian, I have reviewed this application and attest to its accuracy. I hereby grant permission for the applicant to apply for membership in Wall Township First Aid & Rescue Squad: YesNo

Employment:

Present Employer:

Present Employer Phone Number:

Number of Years with Present Employer:

References:



Submit Application:

Online Application Version 1.0 - February 2016