Katonah Bedford Hills Volunteer Ambulance Corps

Volunteers in Spirit - Professionals in Service

Volunteer Application

Click to Download the PDF Form

    Step 1: General Info
    *required
    Name* Date of Birth*
    Address* City, State Zip*
    Home Phone* Work Phone
    Cell Phone Cell Phone Carrier Email* TShirt Size
    Where did you hear about us?
    Driver's License ID # *
    Name of Employer Address of Employer
    Under 18 Years of Age? (All Junior Corps members must have a
    parent or legal guardian sign)*     		YesNo
    Step 2: Previous Affiliations
    Agency Name/Address Contact Name
    Contact Telephone Number
    Step 3: Availability
    The Corps asks that you're available to respond for six hours
    a week, either day or night; when would you be able to
    respond?*     		DaysNightsBoth
    If you are unable to respond to the Corps within the required
    5 minutes, would you be willing to stay at our headquarters
    or within close proximity to the Corps during your
    shift?*     		YesNo
    Please explain why you would like to be a member of the
    Corps:*
    Step 4: References
    Please list the names, addresses and telephone numbers of
    three non-family character references:
    Reference 1* Reference 2*
    Reference 3*
    Step 5: Driving Info
    Have you ever taken a Defensive Driving course?* NoYes
    If Yes, agency/organization where you took your course and
    the date
    Has your license ever been suspended or revoked?* NoYes
    If Yes, explain
    Permission for arrest check: *
    Permission to authorize drivers license checks: *
    Please list any accidents over the past 36 months. Note: All
    driving records will be verified through insurance companies.
    Have you ever been convicted of a felony?* NoYes If so, date of offense
    Signature* Date

    Contact Us

    In an emergency, dial 911.
    Non-emergency: 914.232.5872
    [email protected]

    Professional media inquiries: 914.815.8280

     

    Mailing address:
    Post Office Box 43
    Katonah, NY 10536

    Physical location:
    160 Bedford Road
    Katonah, NY 10536