Sea Bright EMS patch
Sea Bright
Emergency Medical Services

Application for Membership

Please type or print. Fields marked * are required.

Applicant

EMS experience

Training courses (EMT, CPR/BLS, ACLS, PALS, NIMS/ICS, EVOC…)

Background

Have you ever been suspended or removed from a prior emergency services organization?

Have you ever been convicted of a crime or offense?

Have you ever been a defendant or plaintiff of a domestic violence incident?

Certification

I certify that the statements made within this application are true, complete and correct to the best of my knowledge and belief, and are made in good faith. I am aware that any misrepresentation of information supplied by me will result in my disqualification from the selection process. Furthermore, I authorize the Sea Bright Police Department to verify any and all information contained herein and to review my employment, education and criminal history, disciplinary records, and any other records and information from any source as noted in the duly executed Authority and Release form. I have read this Certification and I understand and agree to the conditions imposed herein.

Sign here