Volunteer applications 2024 – Plainsboro Rescue Squad

Name *

First

Last

Confirm that you are an Adult (18+) *

Yes, I am an adult volunteer

Gender *

Male
Female

Age *

Address (You must be a resident of Plainsboro or West Windsor to apply) *

Have you lived here for 3 years or more? *

Yes
No

Previous Address 1

Previous Address 2

Email *

Mobile Phone *

Work Phone

Name of Employer or School *

Have you ever been convicted of a crime? *

Do you have a valid full NJ License *

Yes
No

Do you have any previous volunteer or Squad experience? i.e First Aid, other rescue squad etc *

Do you have EMT, medical training or certifications? If yes please list certifications and expiration dates. *

Thank you for choosing to volunteer at the Plainsboro Rescue Squad. The Squad is run by paid EMTs during the daytime on weekdays, and by volunteers on weeknights from 6pm-6am and all hours during the weekends. Do you have the flexibility to volunteer at least one night from 6pm to 6am? Please check any days you can volunteer. Note: Cadets will be assigned to a shift on one night from 8 to 10p.m. Depending on your training and school schedule we will offer an overnight shift on a case by case basis. *

If explain any regular unavailable times (eg. practice etc) *

Do you travel for business or work with varying times? *

General Health *

Good
Fair
Poor

Do you have any limitations that would prevent you from performing any duties? (Allergies, Night Driving restrictions, lifting etc.) *

Do you have any medical conditions we ought to be aware of? Please explain *

Do you have any infectious diseases or contagious medical conditions? Please explain

Please indicate the squad activities you would most like to involved with *

In your own words describe why you would like to be a member and what being in the Squad would mean to you? *

Please explain what difference you can make by being in the squad. How will you contribute? Mention any other attributes or skills you have that would help the squad activities or administration. *

List any other languages you are fluent in *

How long do you plan to be a member of the squad? Please explain *

Name any existing or past members that you know

How did you become aware of the squad and the membership application process *

Reference 1 Name *

First

Last

Please do not include any family members.

Reference 1 Email *

Reference 2 Phone # *

Relationship to you 1 *

Reference 2 Name *

First

Last

Please do not include any family members

Reference 2 Email *

Reference 2 Phone # *

Relationship to you 2 *

I hereby acknowledge by my submitting this form I am certifying that any and all information provided by me herein, is true and complete to the best of my knowledge. I hereby release to the Plainsboro Rescue Squad membership committee and/or its assigns, permission to verify the information I have provided herein. I agree to comply with all orders, rules, and regulations of the Plainsboro Rescue Squad. The Plainsboro Rescue Squad does not discriminate on the basis of ethnicity, religion or sexual orientation and is a drug free organization. Please note that fingerprinting, a police background check, and a drug screen will be required upon joining the squad. *

Enter your name to acknowledge and certify the information you have entered and accept the terms and conditions to joining the Squad

Enter date and time of your submission *