St. Marys County Advanced Life Support Unit, Inc. (Emergency Medical Services)
ST. MARY’S COUNTY ADVANCED LIFE SUPPORT UNIT
Application for Membership
Telephone
(Work)
(Home)
(Cell)
Drivers License
Number
State
Class
Restrictions
Check Membership Applying for:
EMT-I/P
• State of Maryland Certified.
• Required to stand 2 duty shifts per month.
EMT-B
• Active member in good standing with SMC Rescue Squad or Fire Dept. for at least one year prior to filing the application.
• Written verification of good standing from home squad or dept.
• SMC IV-Tech Certification or class enrollment within 1 year of membership acceptance.
• Required to stand one duty per month.
Associate Member Driver Only (Non-Voting)
• Active Member in good standing with a SMC Rescue Squad or Fire Dept. for at least 2 years prior to filing application.
• 25 years of age
• Current CPR Certification
Auxiliary Member (Non-Voting)
• US Citizen
• Interested in supporting the ALS Unit
Student Member (Non-Voting)
• Enrolled in EMT-I or EMT-P Program recognized by the St. Mary’s County Advanced Life Support Unit.
• Follows the Constitution, By-Laws and SOP’s as established regarding student status.
Current Level of Training:
Training Level
MIEMSS I.D. Number
Expiration Date
Current Affiliation :
Department
No. of Years
Telephone
Previous ALS Certification?
State
No. of Years
Retirement Code No.
Medical (Please provide brief description of any condition that may affect active duty)
Personal References
Name
Address
Telephone
Relationship
Verification of Information
I certify that all the information herein is true and accurate to the best of my knowledge, and that I will uphold the Constitution, By-Laws and Standards Operating Procedures of this organization. I understand that the St. Mary’s County Advanced Life Support Unit membership committee may verify this application. I also authorize and am aware that background checks will be performed.
