Little Neck - Douglaston Community Ambulance Corps. -  APPLICATION FOR MEMBERSHIP
Please use this form to apply to the Little Neck-Douglaston Community Ambulance Corps.

APPLICANTS ARE REMINDED:
-TO CHECK OVER YOUR APPLICATION BEFORE SUBMITTING.
-ANY ERRORS/MISTAKES MAY CAUSE YOUR APPLICATION PROCESS TO BE DELAYED.
-FALSE STATEMENTS/OMISSIONS MADE ON YOUR APPLICATION MAY RESULT IN THE DISQUALIFICATION OF YOUR APPLICATION PROCESS AND/OR REVOCATION OF MEMBERSHIP.
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Email *
Today's Date *
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Full Name *
First, Middle, Last Name. Ex: John Smith Doe
Date of Birth *
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Age *
Sex *
Social Security Number *
Cell Phone Number *
In this format: 718-423-2333
Secondary Phone Number
In this format: 718-423-2333
Full Home Address *
Please use this format: "42-18 Marathon Parkway Little Neck, NY 11363"
***PLEASE READ CAREFULLY THE BELOW POSITIONS BEFORE YOU ANSWER THE NEXT QUESTION***
Emergency Medical Technician-Basic (EMT-B):
Interested applicants who currently possess a valid NYS EMT-B certification can apply for this position. If you are currently enrolled in a NYS EMT-B class, you do not currently possess a valid NYS EMT-B certification yet. Please apply for the position of Attendant.

Attendant:
Interested applicants 18 or older who do not currently possess a valid NYS EMT-B certification but are interested in obtaining an NYS EMT-B certification and/or want to help out may apply for this position.

Youth Corp:
Interested applicants who are ages 15-17 can apply for this position, with parental consent. Youth Corp can only volunteer from 7AM - 10PM.

Dispatcher:
Interested applicants 18 or older who do not wish to ride in the ambulance may apply to be a Dispatcher. Dispatchers must go through the same initial training as Attendants.
Which position are you applying for? *
PLEASE DOUBLE CHECK THE POSITION YOU JUST CHOSE BEFORE YOU CLICK NEXT.
Any errors found in your application WILL delay your application process.
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