Hazlet Cadet Application

Cadet Application
Personal Information
Name

First NameLast Name
Home address
Home #. Street. City. Zip
Home Phone
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
E-mail address
example@example.com
Date of Birth

MonthDayYear
Date
Age
Emergency Contact Information
Name

First NameLast Name
Home Address
Cell Phone
Format: (000) 000-0000.
Relationship
Name

First NameLast Name
Home Address
Cell Phone
Format: (000) 000-0000.
Relationship
Additional Contacts
Name and Contact number
Additional Contacts:
Name and Contact number
School Information:
School Name
School Address
School Phone Number
Format: (000) 000-0000.
Guidance Counselor
Current Grade attending
Questionnaire:
Please check yes or no. If requested, please answer question in space provided
1. Have you ever been involved in the medical field in anyway?
If yes, please specify
2. Are you currently or have been previously certified as an Emergency Medical Technician?
If yes, please specify expiration date

MonthDayYear
Date
3. Are you interested in becoming a Emergency Medical Technician?
4. Do you become faint or uneasy around blood or body fluids?
5. Are you CPR certified?
6. Do you work well under pressure?
7. Do work well with a team?
8. Have you ever been arrested?
9. Have you ever been convicted of a crime?
If yes, please specify any arrests or convictions
Please list any sports or extracurricular activities you are involved in.
Please write a short paragraph explaining your interest in the squad.
Please tell us how you found out about the squad.

Other
If you found us through a Squad member/cadet . Please enter their name here
By signing below, you (cadet applicant) agree to follow all rules set forth by the Hazlet Township First Aid & Rescue Squad Inc. You also agree that all information on this application is deemed true as of the date signed. Failure to comply with all rules and regulations of this organization can lead to suspension and/or expulsion from the organization.
X Cadet Applicant Signature
Date

MonthDayYear
Date
X Parent/Guardian Signature
Date

MonthDayYear
Date
X Cadet Advisor Signature
Date

MonthDayYear
Date
X Squad Chief Signature
Date

MonthDayYear
Date
Should be Empty:

Cadet Application

Personal Information

Emergency Contact Information

School Information:

Questionnaire: