Volunteer Membership - Town of Bristol, Rhode Island

Please indicate your area(s) of interest.*

Emergency Medical Services - Emergency First Responder

Emergency Medical Services - EMT

Emergency Medical Services - Paramedic

Firefighting - Engine Company

Firefighting - Ladder Company

First Name:*

Last Name:*

Address:*

City:*

State:*

Zip Code:*

Are you a U.S. Citizen?*

Yes

No

Primary Phone Number:*

Type of Phone:*

Home

Work

Cell

Email Address:*

Date of Birth:*

Driver's License / I.D. #*

Driver's License / I.D. State*

Have you ever applied to a Fire Department?*

Yes

No

Have you ever been convicted of a crime?*

Yes

No

If yes to either question above, please provide an explanation below.*

Do you have any disabilities that may limit your performance?*

Yes

No

If yes, please describe below.*

Qualifications

None

None
EMT
AEMT
Paramedic

EMS Certifications:*

EMS Certfication(s) Number(s)

Has your EMS license or certification ever been revoked or suspended in any way?

Yes

No

None

None
Firefighter 1
Firefighter 2
Other firefighting-related training

select

Describe any firefighting-related training you have completed.

References

Please provide three (3) references not related to you that you have known for at least three (3) years.

Reference 1:*

Reference Address:*

City:*

State:*

Zip Code:*

Reference Phone Number:*

Reference 2:*

Reference Address:*

City:*

State:*

Zip Code:*

Reference Phone Number:*

Reference 3:*

Reference Address:*

City:*

State:*

Zip Code:*

Reference Phone Number:*

The information solicited in this application is necessary to complete a background investigation. The next step in the process will require all interested persons to submit a copy of a photo ID and complete an authorization for background investigation to be conducted by the Bristol Police Department. This will be completed after the initial screening process.

I hereby acknowledge that the information provided in this application is correct to the best of my knowledge and a background investigation will be required prior to preceding to the next steps in the membership process.

A Background Investigation Form can be downloaded here.

Driver's License / Photo ID:*

Upload

Bristol PD Background Investigation Form*

Upload

Credentials

Upload

Please upload any credentials or certificates that may aid in the application process, such as an EMT License or firefighting training.

Signature:*

Date:*

Email