Hermon Volunteer Rescue & First Aid Squad, Inc.

Employment Application

Personal Information


High School


Other Education

Previous Employment

Previous Job #1

Previous Job #2

Previous Job #3


(Please list three professional references. [MUST BE NON-HVRS MEMBERS])

EMS Experience

Military Experience

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I realize that if I am accepted for membership, I will be giving part of my time to public services. I will be required to give freely of my time to attend rescue calls, meetings, drills and work on committees. I agree to abide by the rules, regulations and procedures set by the Rescue Squad to the best of my ability.

By signing the application, I am giving Hermon Volunteer Rescue & First Aid Squad, Inc. Membership Committee permission to contact all of my references for information regarding the applicant. I also give my permission for the membership committee to do a formal background check as well as a driver’s license check.

Background Check Release Form

As a condition of employment, I give permission for Hermon Volunteer Rescue and First Aid Squad, Inc. to conduct background checks on me, which may include a review of the sexual offender registry, driving history, child abuse and criminal history records. I hereby release and hold harmless from liability Hermon Volunteer Rescue and First Aid Squad, Inc. or any of its employees that may provide such information to my employer.