EVP EMS Volunteer Deployment Form
Please provide us with the information listed below if you are willing to be added to the roster for emergency response. After filling out the form, you will be contacted by an EVP team member for further information.
Full Name (As Listed on Passport)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
City/Town
*
Closest Airport
*
Passport Number
*
Passport Country
*
Passport Expiry Date
*
-
Month
-
Day
Year
Date
Photograph of Passport
*
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Provider Type
*
Please Select
Physician
Nurse
Paramedic
EMT
PA
Other
Current Position/Institution
*
Medical Specialty, If Applicable
Copy of Medical License
*
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CV
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Medical Education
To ensure the smooth approval of your practice in Israel, please upload the following requested documents. We understand that this may in some cases duplicate information you have provided elsewhere, including to the Ministry of Health.
Primary Medical Degree Institution (for MD, DO, BSN, etc.)
Primary Medical Degree/Diploma, if applicable (if you have a medical degree, this field is required).
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Residency Institution (if applicable)
Residency Diploma (if you have completed a residency, this field is required).
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Fellowship Institution (if applicable)
Fellowship Certificate
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Boards Fields (if applicable)
Boards Certificates (if you are board-certified, this field is required).
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Current Medical License Country/ies
Deployment Questions
The questions in this section are designed to allow EVP to determine which individuals are ready to depart at short notice. If a responder is needed, EVP will communicate directly to ensure availability before final confirmation or assignment of a departure date.
If you are professionally proficient or fluent in Hebrew, please check the box below.
Hebrew
I agree that I can be deployed to Israel for up to two weeks.
*
Yes
I have completed the Ministry of Health form and responded to any subsequent Ministry emails asking for documentation. (If not, please mention EVP as the sponsoring organization). The link is here: https://survey.gov.il/en/internationalvolunteers?utm_source=go.gov.il&utm_medium=referral
*
Yes
Can you deploy within the next 48 hours if needed and commit to a 14-day deployment?
*
Yes
No
Can you deploy with two weeks' notice and commit to a 14-day deployment?
*
Yes
No
If needed, are you willing to work in the field with a field medical team? (This could involve triage/treatment teams or EVAC/transport teams).
*
Yes
No
Submit
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