Serve your community

Volunteer Member Application

Apply to become a volunteer member of Upper Deerfield EMS and support our 9-1-1 mission.

Volunteer membership application

Tell us about yourself, your availability, and any EMS credentials you already hold. Prior EMS experience is welcome but not required unless a specific role requires it.

Protecting your information

Do not enter a Social Security number, bank information, patient information, or medical records. Driver-license and certification uploads are stored as protected applicant records and are not attached to notification emails.

Personal information

First name *

M.I.

Last name *

Street address *

City *

State *

ZIP *

Email *

Phone *

Eligibility & licensing

Eligible to work in the United States? *

Are you at least 18 years old? *

Current driver's license? *

Commercial driver's license?

License endorsements

Volunteer interests

Primary interest

Typical availability

EMS, fire, rescue, healthcare, or public-safety experience

Why would you like to volunteer with Upper Deerfield EMS?

Experience, education & references

Employment history

Education & training

Skills, licenses, certifications, proficiencies, or other qualifications

Referred by

How did you hear about us?

Three personal references

Documents

Optional unless requested for the position. Accepted formats: PDF, JPG, PNG. Maximum 8 MB each and 18 MB total per application so the completed application package can be delivered by email.

Driver's license

EMT certification

CPR certification

NREMT certification

Other certification

Resume

Acknowledgment & electronic signature

I certify that the information provided is truthful and complete. I authorize Upper Deerfield EMS to verify information relevant to volunteer membership and understand that additional screening, orientation, credentials, or background checks may be required before membership or operational participation.

I have read and agree to the acknowledgment above, consent to electronic submission, and understand that typing my full name below serves as my electronic signature. *

Full legal name / electronic signature *

This form is not monitored for emergencies. Dial 9-1-1 for emergency assistance.