VEMS Membership Application
Vernon Emergency Medical Services Official Membership Application
Questions? membership@vernonems.com
Volunteer Membership Application

Serve your community. Join VEMS.

Thank you for your interest in membership with Vernon Emergency Medical Services. Please complete this application fully and accurately. Information submitted will be used to evaluate eligibility, verify qualifications, and support the Membership Committee's review.

Professional, compassionate community care Contact the Membership Team

Application guide

Before you begin

01
Complete all required fieldsRequired information is marked with an asterisk.
02
Provide complete historyPrior applications and service with VEMS or either legacy agency should be disclosed.
03
Check your email after submittingThe Membership Team will send confirmation and next-step instructions.
Agency history: VEMS is the successor organization to Vernon Township Ambulance Squad and Glenwood Pochuck Volunteer Ambulance Corps.
VEMS Membership Application Complete all nine sections and review your answers before submitting.
Confidential application information

Applicant Information

Membership category, personal details, and primary contact information.

1
Please choose a membership category.
Full legal name is required.
Date of birth is required.
Please enter a valid phone number.
A valid email address is required.
Street address is required.
City is required.
A two-letter state abbreviation is required.
Postal code is required.

Parent or Guardian Contact

Required for applicants under 18 and for Jr. Cadet or Cadet applicants.

Parent or guardian name is required.
Relationship is required.
A valid parent or guardian phone number is required.
A valid parent or guardian email is required.

Prior VEMS or Legacy-Agency History

Prior applications and prior service with VEMS, Vernon Township Ambulance Squad, or Glenwood Pochuck Volunteer Ambulance Corps.

2

Prior Application History

Include any prior application regardless of whether it was accepted, declined, withdrawn, or left incomplete.

Please answer the prior-application question.

Select each agency and provide the approximate application date and outcome.

Select at least one agency.

Prior Membership or Service

Include service as a member, cadet, officer, employee, volunteer, or other affiliated role.

Please answer the prior-membership question.

Select each agency and provide the role and approximate service period.

Select at least one agency.

Employment and Other Public-Safety Service

Current employment information and prior service with other EMS, fire, rescue, healthcare, dispatch, or public-safety organizations.

3

Current Employment

Other Public-Safety or Healthcare Service

Military Service

Prior military service details, if applicable.

4

Qualifications, Driving, and Screening

Job-related eligibility questions and authorizations used during membership review.

5
i
Initial-application privacy: VEMS does not request a diagnosis, disability history, prescription-medication information, or detailed criminal history on this initial application. Applicants may request an accommodation for the application or membership process by contacting membership@vernonems.com.

Essential Functions

Operational duties may include lifting and moving patients or equipment, climbing stairs, working in adverse weather, and functioning in emergency environments. Requirements vary by membership classification.

Please answer the essential-functions question.
The Membership Team may contact you to discuss the position's essential functions and the application process. Do not include medical details on this form.

Driver's License and Driving Record

Please select an answer.
Please select an answer.

Credential and Organizational Standing

Please select an answer.
Please select an answer.

Screening Authorization

Please select an answer.

Volunteer Availability

Select the days and general periods when you are typically available to serve.

6

Days Available

Please select at least one available day.

General Shift Availability

Please select at least one general period.

Volunteer Commitment Acknowledgment

Review the agency's current service expectations and application process.

7
By applying, you acknowledge the commitment associated with volunteering. Volunteers are required to complete 12 hours of service per week, including a 24-hour rotating weekend shift, as outlined in the agency's Standard Operating Procedures.

Cadets are not required to ride a 12-hour shift on school nights. On non-school nights, cadet participation remains subject to VEMS policy, applicable youth-participation requirements, and any required parent or guardian authorization.
Both acknowledgments are required.

Committee Interest

Select any committees or support areas that interest you.

8

Applicant Certification and Verification

Final certifications, signature, and submission verification.

9
I certify that the information provided in this application is complete and accurate to the best of my knowledge. I understand that material omissions or false statements may result in disqualification from consideration or termination of membership. I authorize VEMS to verify information reasonably related to my application, including prior service, credentials, references, and driving eligibility, subject to applicable policy and law.
All applicant certifications are required.
Both a typed signature and a drawn signature are required.
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Review and submit your application

Upon completion of the application, please check your email for further information.

Vernon Emergency Medical Services · Membership Application · Information is maintained in accordance with agency policy · Revision: July 2026