Application

Bloomsbury Rescue Squad

Volunteers serving since 1953 - Site updated Mar. 4, 2010

Application

To join the Bloomsbury Rescue Squad, you can either complete the online application below (which will be automatically submitted to all of the Squad Officers for immediate review), or you can download an application, in Adobe PDF format, by clicking this link. Once you have completed the application, you can either mail it to us at the address on the application, or you can hand deliver it to us. We are at the Station most days between 10am and 2pm. You can also check our Squad Calendar to see when we have evening activities planned, call us at (908) 479-6221 to see if an Officer is at the Station or e-mail us .

Date
Name:
Email Address:
Home Address
Previous Address if less than 3 years
Home Telephone Number
Work Telephone Number
Cellular Telephone Number
Desired Membership Type
Date of Birth
Place of Birth
List Any/All Fire Departments/Rescue Squads you belong to
May we contact them?
List anyone that recommended you to our Rescue Squad
List any crimes you have been convicted of, including motor vehicle violations.
List your Drivers License number and State
List, in detail, any points or suspension details
Please list any current first aid and/or rescue certifications
If you are a current EMT, please list your ID number
Please list personal reference #1 (Name, Address, Telephone Number)
Please list personal reference #2 (Name, Address, Telephone Number)
EDUCATION: Please list your Grammar School (Name, Address, Year of Graduation, Diploma or Degree)
EDUCATION: Please list your High School (Name, Address, Year of Graduation, Diploma or Degree)
EDUCATION: Please list your College School (Name, Address, Year of Graduation, Diploma or Degree)
EDUCATION: Please list your Vocational/Trade School (Name, Address, Year of Graduation, Diploma or Degree)
Please list any other special qualifications or training
Current Employer:
Current Job Title:
Supervisor:
Work Phone Number:
Did you serve in the Military?
If yes, please list the Branch, Years of service, MOS, Rank, and type of discharge
Marital Status
Do you have any children?	No Yes, Infant - 2 years old 2 years - 5 years old 6 years - 10 years old 11 years - 15 years old 16 years - 20 years old 21 years or older
Please list your hobbies and interests
I acknowledge that if acceptance is obtained under this application, I agree to comply with all orders and rules of the Bloomsbury Rescue Squad. I further agree to submit to a physical exam upon request. The answers to the foregoing are true to the best of my knowledge. It is understood that any false statement on this application is sufficient cause for dismissal. I am giving up my right to press charges against the Bloomsbury Rescue Squad and it's members if I am dismissed from the Squad for any reason.	Yes, I understand and acknowledge my approval. Yes, I understand but do not give my approval. No, I do not understand, please contact me.

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