THE ONE AND ONLY
2016 
NCAC SNOWFLAKE 5K 
ON SAT., DEC. 31, 
was a smashing success.
Thanks to all who ran and helped out. 
RESULTS HERE!

Next Membership Meeting
Wed. June 14
7:00 pm


Next Training:
Tue, May 23
Medical / Legal


Find out more
and fill out an application
♦♦♦
Youth Corps
for high school age volunteers

Volunteer Application

Request for membership consideration & screening interview

Email Address
You must enter a valid email address
Confirm Email Address
Email addresses don't match
Name
You must enter your name.
Date of Birth
You must enter your birth date.
Mo: Day: Year:
Address
You must enter your street address
Apt#:
City
You must enter your city
State
You must enter your state
Zip
You must enter your zip code
Phone Numbers
You must enter at least one phone number
Home: Cell: Work:
Occupation/Employer
You must enter your occupation or employer
Business Address
You must enter your business address
# of years
You must enter the number of years with your occupation/employer
May we use your employer as a reference? Yes
Provide verifiable personal references whom you have known for at least two years:
Reference 1
Name:
Address:
Phone:
How Long?:
Reference 2
Name:
Address:
Phone:
How Long?:
Reference 3
Name:
Address:
Phone:
How Long?:
Do you have any health limitations which would impair your ability to perform routine physical corps duties, such as heavy lifting (150 lbs)? Yes No
If "Yes" please explain:
Do you hold a current valid NY State driver’s license? Yes No
If "Yes":
 
Class: Expires: Mo: Day: Year:
Have you ever been convicted of a felony? Yes No
If "Yes" please explain:
How did the corps come to your attention?
Why do you want to join?
Do you have any experience in emergency medical care? Yes No
List all pertinent certifications:
List your general availability for duty:
You must agree to the below provisions in order to submit the forms.
I CERTIFY BY TYPING MY NAME BELOW THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED IS TRUE TO THE BEST OF MY KNOWLEDGE; I GIVE PERMISSION TO NYACK COMMUNITY AMBULANCE CORPS TO DO A PERSONAL CHECK ON THE INFORMATION PROVIDED

I Agree:
Type your Name:
You must type your name
Characters do not match. Try again.

Enter the characters in the box:

251 North Midland Avenue • Nyack, New York • 10960 • (845) 358-4824