index

Seward Volunteer Ambulance Corps

Providing EMS Services to Seward, Alaska Since 1953

Neighbor Helping Neighbor

PO Box 1136 Seward, Alaska 99664

200 D Street

Phone 907-224-3987

Fax 907-224-2684

Seward Volunteer Ambulance Corps Application

Name (Last, First, Middle I) ______________________________________________

Mailing Address ________________________________________________________

Physical Address ________________________________________________________

Phone Number(s) Home ____________ Work ____________ Cell _____________

Birthdate _____________________ Email Address ___________________________

Length of Residency in the SVAC operating area _____________________________

Employer ______________________________________________________________

Employer Address _______________________________________________________

Sponsoring SVAC Member (must be a current member) ______________________

References (two unrelated)

Name/Address/Phone __________________________________________________

Languages Spoken (including sign language) ________________________________

AKDL# ____________ Type _____ Years Driving _____ Expiration Date ________

Do you have experience with oversized vehicles? Yes _____ No _____

During the last five (5) years have you?

Had your license to drive suspended or revoked? Yes _____ No _____

Been the driver in any accident (MVA)? Yes _____ No _____

Been convicted or cited for traffic violations? Yes _____ No _____

Please explain yes answers.

Certifications Certification Number Date it Expires

________________________________________________________________________

DUTIES OF MEMBERS

It shall be the duties of each member to always be on alert, and on being notified of an

ambulance call to go at once to the ambulance and then to the scene of the emergency,

as described in the standing orders. Members shall do all in their power to properly

assist in alleviation of pain and the saving of life as well as giving proper transporation to

the sick and injured. The member shall at no time afford treatment to any patient that

exceeds the limit of that members Alaska Certification level of training. Members shall

obey the person in charge and the by-laws, rules, regulations and standing orders of the

Corps. Members shall not shirk from any duty that is imposed upon them providing the

request is reasonable and within their scope of practice to perform. Members shall return

with the ambulance to quarters for cleanup and completion of proper reports. In

performing these duties at time you will be asked to work in highly stressful situations,

also on loads (up to and exceeding 300 pounds with assistance from fellow members).

Do you feel that you can carry out the duties of this job as briefly described above?

If no please briefly explain why in the area provided.

_______________________________________________________________________

Signature ____________________________ Date ____________________________