Hunterdon County EMS Chief's Association

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Application Form

If you are interested in volunteering in EMS within Hunterdon County, please fill out the following form. The form will be sent to the EMS Chief for your municipality for review and you will be contacted directly.

If you are not a resident of the Hunterdon County Area, please visit www.volunteerems.org for your local EMS opportunities.

Full Name:
Street Address:
City:
State:
Zip:
Years at present address:
Home Phone Number:
Cell Phone Number:
E-Mail Address:
Date of Birth:
Under 18 years old?:
Sex:
US Citizen?:
Do you have a NJ Drivers License?:
Last school grade completed?:
Are you First Aid certified?:
Are you CPR certified?:
Are you an EMT?:
Are you currently a member of a Squad, Fire Dept or Police Dept?:
If yes, describe?:
Would you be willing to submit to a police background check?:
Additional Comments or Questions: