Arlington Rescue Squad Inc. Membership Application

  • Arlington Rescue Squad Inc. Membership Application

    Thank you for taking the time to apply for membership here at the Arlington Rescue Squad. Volunteers are a very important part of our organization. Your help makes it possible for the rescue squad to continue to provide emergency medical services to our community and surrounding areas. All information contained in this application will be kept confidential and is for the use of Arlington Rescue Squad only. All applicants, if accepted, will be required to have a physical, and be required to take mandatory OSHA and HIPAA training course at time of orientation. All members are required to meet the guidelines and criteria as defined in the Arlington Rescue Squad SOG, By-laws, and Constitution. Arlington Rescue Squad considers applications for membership without regard for race, color, religion, sex national origin, age, disability, veteran status, or any other characteristics protected by law. **ARLINGTON RESCUE SQUAD IS A DRUG-FREE/SMOKE FREE WORKPLACE.**
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  • Have you ever applied to or been a member of, Arlington Rescue Squad Inc?*
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  • Have you ever been a member of another emergency service organization?*
  • Have you ever been convicted of a crime(s) (misdemeanor or felony), or are you presently a defendant in acriminal proceeding? {EMS Rules Sec. 14}*
  • Have you ever had your EMS certification suspended or revoked?*

  • References

    Please include three (3) references, at least one (1) of which is an immediate supervisor.
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  • Are you free of obligation to pay unemployment compensation contributions or in good standing with respect to or in full compliance with a plan to pay any and all unemployment compensation contributions? {21 V.S.A. Section 1378}

  • Let us get to know you!

    Our members are a vital part of the organization, as such we want an opportunity for you to tell us about yourself.

  • Certification of Truth

    By submitting this application I herby certify that all the information and attachments are true and valid to the best of my knowledge. I acknowledge that if an investigation discloses intentional omissions, misrepresentations, or falsifications my application will be rejected. In that case that such intentional omissions, misrepresentations, or falsifications are disclosed after acceptance to the membership of Arlington Rescue Squad Inc. I accept that such discoveries may be cause for termination of membership.
  • Are you currently illegally using drugs or have you only recently stopped illegally using drugs?{EMS Rule 14.1.5.1}
  • Have you ever surrendered, resigned, been denied or had an action taken against any professional license or that you have held in Vermont or elsewhere? {EMS Rule 14.1.5.7}
  • Are you free of obligation to pay child support or in good standing with respect to or in full compliance with a plan to pay any and all child support ?{15 V.S.A. Section 795}
  • Are you in good standing with respect to or in full compliance with a plan to pay any and all VT taxes due?{32 V.S.A. Section 3113}

  • Consent to Perform Background Check

    By submitting this application I herby authorize Arlington Rescue Squad Inc. to perform a background check at their discretion. This may include, but is not limited to: Interviewing former/current employers, Interviewing former/current organizations where I have been a member, Interviewing any other entity of which I have been affiliated with. I herby release any entity or individual that provides information pursuant to this cause from legal action or suit of any kind.
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