Washington Emergency Squad Volunteer Application.

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Dear Washington Emergency Squad Membership Applicant,

Thank you for your interest in volunteering to assist your community. You will find here
the documents necessary to submit an application for membership along with information
on our organization. Please read all the documents carefully.

Upon receipt of your completed application, the Washington Emergency Squad (WES) Line
Officers will submit your name to the WES Trustees for investigation. Upon completion of
their review, the Trustees will return the application to the Line Officers who will arrange
an interview and schedule a time for you to visit our facility and meet some of the members.

If you have any questions, or wish to check on the status of your application please call the
building at 908.689.0909 and leave a message for the Line Officers who will respond as
quickly as possible.

Best regards,

Washington Emergency Squad Members.

ABOUT WES

The Washington Emergency Squad is a non-profit volunteer administered agency that
provides Emergency Medical and Rescue services to Washington Borough and Washington
Township along with Mutual Aid assistance to Franklin Township, Oxford Township and
other surrounding areas as needed.
Our mission is to respond to our communities’ emergency medical and/or rescue calls in the
most effective manner possible. We do this by providing 24/7, 365 services utilizing a blend
of paid and volunteer EMTs, and maintaining a fleet of ambulances along with a rescue
truck and equipment.

HISTORY

Vernon C. “Bab” Oakes founded the Washington Emergency Squad in 1936. It was started
as a "first-aid group" made up of 6 firemen. "Babs" and his men raised money to buy needed
equipment such as a stretcher, blankets, inhalator, leg splints, floodlights, and some
medical and first aid supplies.
On June 24, 1936, squad membership was increased to twelve (12) men. No longer
restricted to fire calls, this well manned and equipped rescue organization became known
as the Washington Fire Department First Aid and Rescue Squad. It was available to the
public for all types of emergency services. By the end of 1936, the squad had answered five
(5) calls. In 1979 Washington Emergency Squad became an independent organization from
the Fire Department and having celebrated over 75 years of uninterrupted service, the
members of the Washington Emergency Squad now run over 1700 calls a year.

Our members fall into three main categories:

Senior: (18yrs minimum)
Probationary
Active
Leave
Honorary

Associate: (18yrs minimum)
EMS Section
Rescue Section
Business/Administration

Junior: (16yrs – 17yrs)

EXPECTATIONS

As a member of the Washington Emergency Squad you will be expected to cover at least a 6 hour period per week. We operate 24 hours per day, 365 day per year and utilize paid staff, provided by Washington Emergency Services, to cover calls that volunteers are unable to cover and weekdays 06:00 - 18:00. Members are also asked to respond to “scramble calls” that occur when the assigned duty crew is busy or needs additional manpower. In addition to providing emergency response coverage all members are expected to attend regular monthly meetings (held the 3rd Monday of each month at 19:30 hour), and participate in scheduled drills and training (1st and 2nd Wednesday evenings at 19:00 hours) and take part in special activities, including standbys and parades.

SENIOR MEMBERSHIP

To achieve full Senior Membership you must be capable of performing the job
responsibilities of an Emergency Medical Technician (EMT). This requires certain physical
capabilities, such as the ability to lift equipment and stretchers with patients on them; to
drive under hazardous conditions; the mental capability to meet and maintain training
levels; and the emotional capability to deal with stressful situations.

Members must be capable of completing classroom work at the beginning college level.
Initial EMT training is 120 hours. EMT-Bs must also obtain and annually re-certify in a
cardiopulmonary resuscitation (CPR) course for professional health care providers. This
course if offered periodically by instructors specifically for Squad members.

EMT-B’s must re-certify every 3 years, by completing successfully a refresher course and
by obtaining continuing education credits (CEU’s). Washington Emergency Squad covers
the cost of each member’s EMS-related training and recertification through approved CEU
courses.

ASSOCIATE MEMBERSHIP
As an Associate Member you have to be in good standing with your home municipalities rescue squad which you are a member of. You will not be able to hold any positions and will not have the privilege to vote. You will only have to attend 50% of scheduled meetings and drill nights for the Squad. You will still be held to the 6 hours per week of riding time.

Membership Application

Washington Emergency Squad considers applications for membership without regard to
race, color, national origin, ancestry, religion, sex, age, disability, political belief, military
service, or any other protected class. Washington Emergency Squad IS A DRUG-FREE
WORKPLACE

Email *

Membership Category

What are you applying for *

Senior Membership

Associate Membership

Junior Membership (16 years - 17 years)

Personal Information

Name in the order of Last, First, Middle *

Current Address *

City, State, and Zip Code *

Primary Phone Number *

Other Phone Number

Contact Email *

Social Security Number *

Driver's License #

Background Information

A conviction will not necessarily disqualify you from membership.

Have you ever been convicted, or pled guilty or no contest to a felony or misdemeanor, including a DUI/DWI, disorderly persons, or similar offense, had any moving violations, or had your license revoked or suspended? *

Yes

If yes to previous question please explain.

List all moving violations (convictions) and accidents and any suspensions or revocations of your license in the last five years *

Have you ever been subjected to limitation, suspension, or termination of your right to practice in a health care occupation or voluntarily surrendered a heath care licensure in any state or to an agency authorizing the legal right to work? *

Yes

If yes to previous question please explain.

EMS History

Have you ever worked/volunteered for this organization *

Yes

If yes when did you start

YYYY

If yes when did you end

YYYY

If yes what was your prior Position(s) here

If yes what was your reason for leaving

Why do you want to volunteer with the Washington Emergency Squad? *

Have you ever been, or are you a member of any other emergency service (EMS, Rescue, orFire), paid or volunteer? *

Yes

If you answered yes to being a member of any other emergency service please fill out details below there will be slots for 3 Organizations.

What is the name of the FIRST Agency/Organization

What was your position and a description of your duties and responsibilities

Start Date

YYYY

End Date

YYYY

Organizations Telephone Number

Reason for leaving

May we contact them?

Yes

Clear selection

What is the name of the SECOND Agency/Organization

What was your position and a description of your duties and responsibilities

Start Date

YYYY

End Date

YYYY

Organizations Telephone Number

Reason for leaving

May we contact them?

Yes

Clear selection

What is the name of the THIRD Agency/Organization

What was your position and a description of your duties and responsibilities

Start Date

YYYY

End Date

YYYY

Organizations Telephone Number

Reason for leaving

May we contact them?

Yes

Clear selection

Are you currently Active Reserve Status with the Military? *

Yes

If yes, please list the Branch of Service, Date Started, Date Ended, Your Rank, Discharge Date, and Location

Certification Information

(List only current certifications. A photocopies required at interview)

If you have your CPR, EMT, National Registry, EVOC/CEVO, BTLS, or CDL certifications. List the certification, Cert number, Expiration Date, and Certifying Agency.

References

Do you have any relatives or friends working/volunteering here? *

Yes

If yes to previous question please list the members

List three persons we will contact, other than relatives, who are able to provide character references.

(Junior membership applicants should include one (1) reference from current school.)

List the FIRST references, Full Name, Address, Occupation, Years Known, Telephone Number, and Email. *

List the SECOND references, Full Name, Address, Occupation, Years Known, Telephone Number, and Email. *

List the THIRD references, Full Name, Address, Occupation, Years Known, Telephone Number, and Email. *

ACKNOWLEDGMENT

I certify that the information I have given on this application is true, complete and correct,
and I understand that any false information, or the omission of information may be
considered as sufficient reason for dismissal of membership. I further understand that this
application does not mean automatic acceptance as a member of Washington Emergency
Squad.

I hereby authorize Washington Emergency Squad to investigate my background history
and to make any further investigation deemed necessary in connection with my application
for membership, including a criminal history check, driving history check, child abuse
clearance check, and other such inquiries. I release Washington Emergency Squad and all
informants from all liability resulting from such inquiries. I waive all rights to see or
review the information so furnished and agree to reimburse the Washington Emergency
Squad for all fees related to the background check in the event that the results of such
check deem me unqualified to become a member.

By selecting the the Accept box you are agreeing to the terms listed in the acknowledgment section above this question. After that please put todays date in the other box in MM/DD/YYYY format. *

Other:

Required

If applicant is under 18, Parent also has to read and Accept the Acknowledgment section. After accepting please click other and enter your first and last name along with todays date in MM/DD/YYYY format.

Other:

School records release for Junior Member applicants. AUTHORIZED BY APPLICANTS PARENT: (I authorize the release of my child’s school records to the Trustees of the WashingtonEmergency Squad.) . After authorizing please check the other box and put in your First and Last Name, Address and Todays Date.

I give authorization to the trustees of the Washington Emergency Squad

Other:

A copy of your responses will be emailed to the address you provided.

Submit

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