Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Date of birth: *

MM

DD

YYYY

Level of EMS Training *

Must provide copy of current certification card at interview - If no level of EMS certification you may have a delayed admission process. Please obtain EMS certification with the link provided.

First Aid

EMT (or higher)

Have you previously applied for membership? *

Yes

No

Are you a current or former member of another Ambulance or Fire Company? *

Yes

No

Have you ever been convicted of a crime? *

Yes

No

Please accept the following terms: *

Upon continuation of the application process you will be needed to provide:

A letter of recommendation from either a previous/current agency, employer or a Friend/Relative

A copy of your current Certifications (EMS and CPR cards)

A copy of your Driver's License

A $10.00 application fee payable to Boston Emergency Squad

Do you accept the above terms? *

Yes

No

Are you aware this is in Boston, New York? *

Yes

Do you currently have any EMS certifications? *

If not you may have a delayed admission process. Either reach out for more information or use https://atlas.heart.org/find-class to obtain certification.

I have certification

I do not have certification