Ambulance Driver Application Form

What An HNFR Ambulance Driver Does

Duties

A rescue driver is responsible for the safe operation of the ambulance during a 911 call. The driver learns where essential items are located i the ambulance so he/she is able to assist other members of the team at the location of an emergency and at the hospital. The driver assists in decontaminating the ambulance and equipment after a call. Unless specifically asked to do so by a medical professional, a rescue driver is not responsible for (or permitted to participate in) medical care.

Requirements

• A valid driver’s license.
• Present evidence of a seasonal flu shot, or sign a declination form.
• Agree to an initial and annual driving record check and an initial criminal background check.
• Bureau of Labor Standards initial and annual training (HFNR provides)
• In-house driver training and assistance with applying for a Maine EMS Ambulance Operator number.
• Obtain Emergency Vehicle Operator Certification (EVOC).

Responsibilities

• At least one 12-hour shift weekly
• Training at the HNFR Fire Station (2 hours monthly)
• You will receive a pager and radio for use in monitoring your shift at home or at the station.

Application Form

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Legal Name *

First

Middle

Last

Today's Date *

Mailing Address *

Address Line 1

Address Line 2

City

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Zip Code

Physical Address (if different)

Address Line 1

Address Line 2

City

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Zip Code

Home Phone *

Cell Phone

Email Address *

Best Time(s) to Contact You *

Place of Employment *

Occupation *

Work Phone

Emergency Contact *

First

Last

Relation *

Emergency Contact Address

Address Line 1

Address Line 2

City

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Zip Code

Emergency Contact Phone *

Why do you want to volunteer? *

Please indicate any other training or experience that may be of value to HNFR.

Please provide three references

Reference 1 *

First

Last

(if Reference criminal

Reference 1 Address

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Reference 1 Phone *

Reference 2 *

First

Last

Reference 2 Address

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Reference 2 Phone *

Reference 3 *

First

Last

Reference 3 Address

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Reference 3 Phone *

Entering my name below attests to the accuracy of the information provided and releases the fire department to obtain a driving record history, contact references and complete a criminal background check.

Name *

Submit Application