Applicant Name:

1) How long, and in what capacity, have you known this applicant?

2) How would you rate this applicant's dependability?

3) How would you evaluate this applicant's initiative?

4) Please comment on this applicant's integrity, honesty, and ability to maintain the confidential nature of our business.

5) In your opinion, is this applicant able to perform under stressful situations?  Please provide an example.

6) To your knowledge, has this applicant been involved in any activities which demonstrate concern for others?  Please describe.

7) Please comment on the general health of the applicant, keeping in mind that our volunteers are required to lift and carry stretchers, ascend and descend stairs while carrying equipment, maintain precarious positions during extrications, etc.

8) Can you offer any further insights regarding this applicant's qualifications to become a member of the Morristown Ambulance Squad, Inc.?

Your Name:
Street Address:
City, State & Zip:
Phone:
Relationship to Applicant:
Years Known:
Today's Date:

Submit completed references to captain@morristownambulance.org