SPAC: Association Application (Version 1.0) Logo
  • Stony Point Ambulance Corps

    Association Application
  • Dear Applicant,  

    We are thrilled to receive your application for membership with the Stony Point Ambulance Corps. Thank you for expressing your interest in joining our team of dedicated volunteers who provide life-saving services to our community.

    We understand that completing an application can be a time-consuming process, but please know that your efforts are greatly appreciated. Your commitment to providing accurate and detailed information is essential to ensuring that we can evaluate your application thoroughly and fairly. Please review each section carefully, including the acknowledgement statements, prior to submitting your application.

    Upon submission of your completed application, the membership committee at Stony Point Ambulance Corps will begin the review process. At the completion of the application review, we will contact you to arrange the next steps in our membership process.

    Once again, thank you for your interest in becoming a member of the Stony Point Ambulance Corps, Inc. We are excited to learn more about you and to have the opportunity to work together to serve our community.

    For any additional inquiry or information, please reach out to membership@spacems.org and we will do our best to follow up in a timely manner.

  • Contact Information:

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  • EMS Experience

    Provide at least one place of EMS involvement if applicable. Begin with your current or most recent EMS involvement.
    • Agency (1) 
    • Agency (2) 
  • Certifications

    Provide the status of the following certifications. Physical copies of all certifications must be present at the time and date of your interview.
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  • References

    To the best of your ability, please list three (3) references that you are NOT related to, including professional references or character references. Please include the reference’s full name, address, mobile phone number (please do not provide work phone number, direct contact method is preferred), email, occupation description and your relationship to the reference. Please inform the references you list to expect one of our representatives to contact them.
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  • Federal Driver's Protection Act:

    Authorization to Obtain Motor Vehicle Report
  • For the sole purpose of the determination and evaluation of my motor vehicle authorize the Stony Point Ambulance Corps. and its insurance carrier to obtain my Motor Vehicle Record. I understand that this record may contain personal information* in addition to any/and driver violations and/or accidents, which may be on record through the NYS Department of Motor Vehicles. 

    I also authorize the release of the following information to my employer:

    • Driver License Number
    • Driver License State
    • Date of Birth
    • Street Address

    *Personal information means information that identifies an individual including an individual’s photograph,  social security number, driver’s license identification number, name, address, and telephone number. It does not include information on vehicle accidents, driving violations, and driver status. 

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  • Records Inquiry:

    Authorization to make Records Inquiries
  • I authorize the Stony Point Ambulance Corps, to make inquiries into all my records, including but not limited to criminal history, driving records, as well as employment, education, and training history. I further authorize and give permission to the Corps to contact the references I designated in my application for employment with the Stony Point Ambulance Corps. I understand that all information will be kept confidential and used for the purpose of my eligibility for employment with the Corps and services of the Corps to the community.

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  • Association Application Acknowledgment :

  • I fully understand and certify the following:

    1. The information provided in this application is complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or willful omission of facts called for in this application may jeopardize my eligibility for membership now or in the future.  
    2. I will be required to participate in an interview with the Membership Committee and be subject to applicable background checks as part of the application process. 
    3. I give Stony Point Ambulance Corps. and/or Officers of the Corps permission to thoroughly investigate and verify all information provided in this application, or related associated documentation, and during interviews. I authorize all references named herein unless otherwise noted, to provide any information requested about me, and I release them from liability for damage in providing this information. 
    4. I understand that Stony Point Ambulance Corps. requires a minimum availability of 12 hours per month. 
    5.  I will be required to be complete training as either an EMT, EVO (Driver), or both.
    6. I understand that, if accepted into Stony Point Ambulance Corps, I will be required to follow all Bylaws and Standard Operating Procedures. 
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