JAMES CITY VOLUNTEER RESCUE SQUAD
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    ​Forms - Application for Volunteer Membership

    Updated June 2015.  To all applicants:  Please submit this complete application.  All necessary additional and sensitive documents should be brought in person to the James City Rescue Squad. Any incomplete applications received will NOT be processed. All references will be contacted to ensure the accuracy of information provided.  

    Application Instruction Sheet
    (PLEASE READ THE ENTIRE INSTRUCTIONS)
     
    We thank you for you interest in joining the James City Rescue Squad! Please remember that becoming a volunteer requires a significant time investment, but can be a very rewarding experience.
     
    Any person is eligible to apply for membership provided that:
     
    -Applicant is at least sixteen (16) years of age.
    -Applicant must submit to a criminal background check with fingerprinting and be eligible for employment by the Virginia OEMS per VAOEMS Rules and Regulations.
    -Lives with in the allowed jurisdictions.
     
    Previous EMS experience is NOT required to apply, but the James City Rescue Squad also encourages and welcomes those with previous experience to join, and will provide and assist all new members in receiving all required training and certifications.
     
    There are several types of membership. These are outlined below:
     
    Active Member: Active membership is for those applicants who are interested in becoming an EMT and participate in operational rescue squad activities. All applicants over the age of eighteen (18) are eligible for active membership. All active members of the squad are required to attend fifty (50) percent of all scheduled squad meeting and trainings, must be enrolled in an EMT course within one year of joining, and must devote a minimum of twelve (12) hours per month actively volunteering.
     
    Student Member: Applicants who are sixteen (16) years of age or older and are currently enrolled in high school or college are eligible to become a student member. Student members perform the same function as active members, with some limitations as regulated by the Office of EMS. Student members are eligible for Active membership upon completion of their schooling.
     
    Associate Member: The squad also accepts applications for Associate members. Associate members are those who are interested in assisting the squad with fundraising functions and special events. Associate members DO NOT participate in operational rescue activities, nor will they be required to receive EMS training.  This is a non-voting member.
     
    Administrative Member: Applicants who are interested in the administrative roles of the Rescue Squad who do not wish to participate in Operational activities.  Applicants must possess knowledge, skills and abilities that can enhance the organization at the administrative level.  All applicants over the age of eighteen (18) are eligible. All administrative members of the squad are required to attend fifty (50) percent of all scheduled squad meeting, and must devote a minimum of twelve (12) hours per month actively volunteering.
    Application process for all types of membership
     
    Applications are accepted on an on-going basis.  Acceptance into the Squad is dependent upon successful completion of the application, fingerprinting and background check, driving record, and membership majority vote.  
     
    1. Obtain an application for membership AND TWO (2) fingerprint cards.  Applicants should have a current member listed as a sponsor on the application form.
    1. Applicants who are applying for Student Membership and are required to complete and sign the “student member waiver.” This form must also be signed by a parent/legal guardian.
    2. See attached instructions for fingerprint cards process and where to send them – BOTH must be submitted.
     
    2. Provide a copy of your driver’s license, a copy of your current driving record, as well as a completed driving record check authorization form (to include signature), found within your application package.

    • Applicants who are new to the area or are from out of state are required to submit their driving record from their last state of residence along with their application if they do not have a current VA DMV record.
     
    *Note: Having a poor driving record does not necessarily prevent applicants from being accepted into the squad, but it may be preclude the applicant from driving any apparatus. The James City Rescue Squad uses this information to evaluate for risk management purposes and decisions.
     
    3. Submit a picture of yourself attached to your application materials. A professional photo is not required, but the picture must be clear enough for us to accurately identify you when reviewing your application.
     
    4. Complete the eight (8) required on-line classes that are listed on page 8.
     
    5. Submit all application materials including:
    • completed application
    • picture
    • copy of driver’s license
    • DMV record
    • a signed driving record check authorization form
    • a signed background check authorization form
    • student waiver (if required)
    • a copy of required certifications (from page 8)
    • a copy of any certifications that you may have
     
    *****There is a lockable blue “membership application box” located in the Rescue Squad Office.  Please turn your COMPLETE application packet in its original envelope into this box ONLY!!  Do not give it to anyone to turn in for you, as there is protected personal information required on these forms that is not for public access.*****
     
    5. After application review, your application is presented by the Membership Committee Chair to the first General Membership Business Meeting following the submission of your application; this is considered your first reading. These meetings are held on the 4th Monday of every month. Applicants are not required to be present for this meeting; however, attendance is encouraged.
     
    6. Following your first reading, and after the Background Check is received from VA OEMS, your application will be presented to the Board of Directors at their next regularly scheduled Board meeting.  Board meetings are held the 2nd Monday of every month.  You are required to attend this Board Meeting for an Interview with administrative and line officers.  A representative from the Membership Committee will contact you to schedule this interview.  Following your scheduled meeting, the Board will make a recommendation to the General Membership based on the applicant’s background check and interview results.
    *Note:  The Background Check must be received PRIOR to membership affiliation being voted upon.  This may mean a delay in scheduling the Board Interview, depending on when the Application Packet is submitted and the turnaround time for the Background Check to be completed.  This is a STATE OEMS requirement.
     
    7. At the next General Membership Business Meeting, following the interview, the applicant may be accepted for membership. This is determined by a majority vote by the membership body.
     
    If you have any questions, please feel free to contact the James City Rescue Squad at
    (757)566-1905, and ask to speak to a member of the Membership Committee or the President.

    Independent Study On-Line Application Requirements
    The following eight (8) courses are required to be considered for membership with JCVRS, please attach course completion certificates with your application: 
    1. Blood-borne Pathogens:
    • http://www.saferesponse.com/users/sign_up
    As soon as you finish the registration, the course opens automatically
    1. National Fire Academy – Emergency Management Institute NIMS/ICS courses:
    • IS-700.A http://training.fema.gov/EMIWeb/IS/courseOverview.aspx?code=IS-700.a
    • IS-100.B http://training.fema.gov/EMIWeb/IS/courseOverview.aspx?code=IS-100.b
    • IS-200.B https://training.fema.gov/EMIWeb/IS/courseOverview.aspx?code=is-200.b
    • IS-800.B https://training.fema.gov/EMIWeb/IS/courseOverview.aspx?code=IS-800.b
    1. Virginia Department of Fire Programs: Knowledge Center – need to register for an account @
    http://vdfp.virginia.gov/training_higher_education/virtual_classroom.htm
    • To take the Hazmat Course: after registered, enter the training site, click on “Learning Center”, click “Course Catalog”, in Search Text box type in  “VDFP Hazardous”, there will be 6 (six) modules for you to enroll into and take.  Click on the module 1, after it opens there is a “Suggested Bundles” box – Click on the bundle, when it opens, click on “Access Item” and begin.
    1. TEEX:
    • WMD/Terrorism: AWR 111 https://teexweb.tamu.edu/teex.cfm?pageid=training&templateid=14&area=teex&browse=201
    • WMD/Terrorism: AWR 160  https://teexweb.tamu.edu/teex.cfm?pageid=training&templateid=14&area=teex&browse=201
         
    ***NOTE:  Applications will not be processed without copies of these courses attached.***

    For Official Use Only - Application for Volunteer Membership.  

    Active Member: Active membership is for those applicants who are interested in becoming an EMT and participate in operational rescue squad activities. All applicants over the age of eighteen (18) are eligible for active membership. All active members of the squad are required to attend fifty (50) percent of all scheduled squad meeting and trainings, must be enrolled in an EMT course within one year of joining, and must devote a minimum of twelve (12) hours per month actively volunteering. Student Member: Applicants who are sixteen (16) years of age or older and are currently enrolled in high school or college are eligible to become a student member. Student members perform the same function as active members, with some limitations as regulated by the Office of EMS. Student members are eligible for Active membership upon completion of their schooling. Associate Member: The squad also accepts applications for Associate members. Associate members are those who are interested in assisting the squad with fundraising functions and special events. Associate members DO NOT participate in operational rescue activities, nor will they be required to receive EMS training. This is a non-voting member. Administrative Member: Applicants who are interested in the administrative roles of the Rescue Squad who do not wish to participate in Operational activities. Applicants must possess knowledge, skills and abilities that can enhance the organization at the administrative level. All applicants over the age of eighteen (18) are eligible. All administrative members of the squad are required to attend fifty (50) percent of all scheduled squad meeting, and must devote a minimum of twelve (12) hours per month actively volunteering.
    Employment Information

    ​Employer 1
    Employer 2
    Student Information - If Applicable
    Experience - Previous EMT or Fire #1
    Experience - Previous EMT or Fire #2
    If you answered yes to question #4, please explain
    [object Object]
    References
    2.  Please list three character references who are not relatives or past/present employers:


    Background information:
    LEASE NOTE THAT ALL JAMES CITY RESCUE SQUAD APPLICANTS ARE REQUIRED TO UNDERGO A DEPARTMENT OF MOTOR VEHICLES DRIVING RECORD CHECK AND A CRIMINAL BACKGROUND CHECK. THESE CHECKS WILL BE PERFORMED BY THE JAMES CITY RESCUE SQUAD; AND/OR THE JAMES CITY BRUTON VOLUNTEER FIRE DEPARTMENT MEMBERSHIP COMMITTEE(S); AND/OR THE VIRGINIA OFFICE OF EMS; AND/OR THE VIRGINIA STATE POLICE; AND/OR THE FEDERAL BUREAU OF INVESTIGATION.
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Application for Volunteer Membership
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Picture
Picture

    Application for Volunteer Membership


    I hereby propose
    Last Name / First Name

    for membership.

    Applicant sponsored by
    Last Name / First Name

    Personal Data:

    Personal Data:

    MM / DD / YYYY

    Present Address:


    Resident in area:

    Contact information:

    xxx - xxx - xxxx
    xxx - xxx - xxxx
    xxx - xxx - xxxx

    Employment Information:

    Present Employer:


    Employed:
    Last Name / First Name
    xxx - xxx - xxxx

    Employed:
    Last Name / First Name
    xxx - xxx - xxxx

    Student Information (if applicable):

    School:


    Estimated time of completion:
    Last Name / First Name
    xxx - xxx - xxxx

    Experience:

    EMS/Fire:


    Time of service:
    Last Name / First Name
    xxx - xxx - xxxx
    If Yes, please explain:

    Time of Service:
    Last Name / First Name
    xxx - xxx - xxxx

    References:

    Please list 3 (three) character references who are not relatives or past/present employers:

    Reference #1:


    Time known:
    xxx - xxx - xxxx

    Reference #2:


    Time known:
    xxx - xxx - xxxx

    Reference #3:


    Time known:
    xxx - xxx - xxxx

    Background Information:

    If Yes, please provide details:

    Time of Service:
    If Yes, please provide details:
    MM / DD / YYYY
    If Yes, please explain:
    MM / YYYY
    MM / YYYY
    MM / YYYY
    MM / YYYY
    If Yes, please explain below in detail. Provide the date of charge, the city in which the incident occurred, what the charge was, and the final disposition in each case:
    MM / DD / YYYY
    MM / DD / YYYY
    MM / DD / YYYY
    PLEASE NOTE THAT ALL JAMES CITY RESCUE SQUAD APPLICANTS ARE REQUIRED TO UNDERGO A DEPARTMENT OF MOTOR VEHICLES DRIVING RECORD CHECK AND A CRIMINAL BACKGROUND CHECK. THESE CHECKS WILL BE PERFORMED BY THE JAMES CITY RESCUE SQUAD; AND/OR THE JAMES CITY BRUTON VOLUNTEER FIRE DEPARTMENT MEMBERSHIP COMMITTEE(S); AND/OR THE VIRGINIA OFFICE OF EMS; AND/OR THE VIRGINIA STATE POLICE; AND/OR THE FEDERAL BUREAU OF INVESTIGATION.

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  • Home
  • About
    • Mission, History, Commitment
    • EMT Oath
    • Links
  • Apply
  • Events
  • Contact
  • Community
  • Donate