Putnam Valley Volunteer Ambulance Corps

2022 EMS Responses
Jan. 88
Feb. 81
March 67
April 72
May 93
June 74
July
Aug.
Sept.
Oct.
Nov
Dec
Total 475

Past Call Stats
2021 854
2020 699
2019 765
2018 774
2017 653
2016 566
2015 565
2014 569
2013 n/a
2012 707
2011 676
2010 686
2009 716
2008 695

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August 22, 2008
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Visitors Today
Aug 17, 2022
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Members Area


Applications

Required   Indicates Required Field
What would you like to join as?
Application Type: Required Riding Member
Associate Member
Personal Information
First Name: Required
Last Name: Required
Date of Birth: Required
Social Security:
Address: Required
Home Phone: Required
Work Phone:
Cell Phone:
Email:
Additional Email:
Emergency Contact Information
Name: Required
Phone : Required
Relation: Required
Employer Information
Name of Company:
Name of Supervisor:
Phone Number:
Work Address:
Related Experience
Do you have any related experience in the emergency services or health care field? If so please list:
Do you have your NYS EMT/CFR certifications, CPR or First Aid?
NYS Certifications: EMT
CFR
NYS #:
Exp:
Other Certifications: CPR
First Aid
CPR Exp:
First Aid Exp:
Medical Information
Are you presently under a physician's care for, taking any medications for, or do you have any physical condition that would impair your operation of an emergency vehicle, your use of electronic equipment or your vision, hearing, or ability to lift?:
Have you been arrested for and/or convicted of any crime(s)?: Yes
No
Please list 3 non-personal character references who can be contacted
Ref 1 Name: Required
Ref 1 Address: Required
Ref 1 Phone Number: Required
Ref 1 Relation: Required
Ref 2 Name: Required
Ref 2 Address: Required
Ref 2 Phone Number: Required
Ref 2 Relation: Required
Ref 3 Name: Required
Ref 3 Address: Required
Ref 3 Phone Number: Required
Ref 3 Relation: Required
Are you a member or have you ever been a member of any other Fire Department or Ambulance Corps?: Yes
No
Agency Name:
Agency Address:
Agency Phone Number:
Commanding Officer's Name and Title:
Are you acquainted with any present or past member of the Putnam Valley Volunteer Ambulance Corps and if so who? :

By submitting below the applicant certifies that this information is factual to the best of his/her knowledge. Information on this form will be considered confidential and will not be divulged to any one outside the Corps. However the Corps reserves the right to verify the information provided and to contact the references supplied by the applicant. If there is any condition or issue in the experience of the applicant that might adversely affect this application, the applicant should note that on this application and/or discuss it with the membership committee contact. Meeting are held once the Membership Committee has gone through the process of reviewing your application and you will be advised when to come and be officially interviewed.





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Putnam Valley
Volunteer Ambulance Corps

P.O. Box 141
Putnam Valley, NY 10579

Emergency Dial 911
Office: 845-526-3119
Fax: 845-526-6561
   
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