Prospective EMT Application

Prospective EMT Form

The following form must be completed by prospective Emergency Medical Technicians (EMTs) who wish to receive a Training Fund Form (TFF) from the Tenafly Volunteer Ambulance Corps (TVAC). Prospective EMTs must also complete and submit a Membership Application in order to be considered for membership and a TFF as NJ State requirements require individuals to be members in good standing of a qualifying volunteer ambulance department prior to receive funding.
Prospective Member Information

Please complete the following section to provide TVAC's Membership Committee with the necessary information needed to grant probationary membership and a TFF.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Why do you want to become an EMT for TVAC?*
What skills and strategies will you utilize to be sure you complete the EMT course successfully?*
How do you plan to balance the time commitment of both the EMT course and membership at TVAC with your other responsibilities?*
What would you do if you were having difficulties obtaining your EMT certification or fulfilling your requirements of membership?*
What qualities and experiences do you have that would make you a good member?*
How do you work with and communicate with others?*
Provide an example of a time you were in a difficult or high-stress situation. How did you handle it? What did you learn from it?*
Identified EMT Course

Please complete the following section to inform TVAC's Membership Committee of the EMT Initial Course that has been identified.
To locate available EMT courses local to TVAC, please visit:

https://www.communitysafetyconsultants.com/emt.htm

https://emsregistration.bergen.org/

https://www.trainingcentertechnologies.com/LessStress/CourseEnrollment.aspx?strSort=EMT

https://www.rwjbh.org/treatment-care/training-center/emt-training-classes/emt-initial-training/

*Please confirm there is space available in the identified EMT Course with the respective company and that the course starts at least 60 days prior to the form submission date to ensure sufficient time to be approved for membership PRIOR to submitting this form.

Individuals may enlist in an alternative EMT course but can only receive a TFF for New Jersey courses.
Identified EMT Course Company*

Bergen County EMS Training CenterCommunity Safety ConsultantsLess StressRWJBarnabas HealthOther
Identified EMT Course Start Date*

MonthDayYear
Date
Identified EMT Course End Date*

MonthDayYear
Date
Identified EMT Course's NJ EMT Course Approval Number
NJEMS and NREMT Account Information

In order to receive a TFF and enroll in an EMT course, prospective members must create NJEMS and NREMT accounts. Please review the following instructions to create the accounts and then provide the necessary information to confirm account creation.
To create an NJEMS account, please visit*:

https://njems.njlincs.net/acr/step1.jsp

*Please note you must be at least 16 years old PRIOR to creating an account.
NJEMS 6-Digit ID*
To create an NREMT account, please visit:

https://my.nremt.org/rwd/account/create
NREMT EMS ID*
BLS CPR Certification

Please upload a valid, BLS CPR certification below. If you are not BLS CPR certified by a valid Training Agency, please email cpr@tenaflyambulance.com to schedule a course.
To view valid Training Agencies and Certifications, please visit:

https://www.nj.gov/health/ems/documents/CPR%20Approved%20Certifications%205_3_2024.pdf
File Upload

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Confirmation

Please complete and sign the below agreement.
I, First Name* Last Name* , confirm that I am aware of the requirements of membership of the Tenafly Volunteer Ambulance Corps and wish to be considered for probationary membership in order to become an EMT.

I understand that if approved, I will be granted probationary membership and a TFF to serve as payment and sponsorship for an EMT course and in exchange, I must provide at least one year of service to TVAC. I understand that my full membership will be granted pending a valid BLS CPR and EMT certification. I understand that if I do not successfully obtain the necessary certifications, I must notify the E-Board by emailing eboard@tenaflyambulance.com to ensure alternative arrangements are made.
Prospective Member Signature*

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Guardian Information

Please have a guardian complete and sign below if under 18 years old.
Name

First NameLast Name
Relationship
Guardian Signature

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Prospective EMT Form

Prospective Member Information

Identified EMT Course

NJEMS and NREMT Account Information

BLS CPR Certification

Confirmation

Guardian Information