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Sparta Ambulance Squad

About Us
Apply for Membership/Employment
Contact Us
Current Events
Donate
Join
Location
Photos
Welcome

Apply for Membership/Employment

We’re excited that you want to join us!

Before you apply, please take note of the following:

Have the following items ready before beginning:

New Jersey Driver’s License (all roles except Associate) in scanned format (10MB or less in size)
Current certifications (EMT, CPR, etc.) (Required for Per Diem EMT role) in scanned format (10MB or less in size)
Employee history/Volunteer experience
Personal references
For Cadet applicants, have your parent present to review and sign the application

Your signature is captured at the end of this application, best entered via a touch screen (phone/laptop) or by using a mouse.

Please select your role correctly as the application is customized per role.

It should take approximately 10-15 minutes to complete the application if you have all materials ready.

Before you begin

Have the following items ready before beginning

New Jersey Driver’s License (all roles except Associate) in scanned format
Current certifications (EMT, CPR, etc.) (Required for Per Diem EMT role) in scanned format
Other post-education certifications in scanned format – Optional
Employee history/Volunteer experience
Personal references
For Cadet Program applicants:
- A scanned image of your most recent report card -or-
- A scanned letter from your guidance counselor showing of proof that you maintain a “C” or greater average
  in all classes.
- Have your parent present to review and sign the application

All scanned files must be in common image formats (JPEG, PNG, PDF) and must be no larger than 10MB in size each.

Your drawn signature is captured at the end of this application, best entered via a touch screen (phone/laptop) or by using a mouse.

It should take approximately 15-20 minutes to complete the application if you have all materials ready.

Required active Certifications and Licenses for Per Diem EMT

New Jersey EMT Certification
American Red Cross CPR/AED for Professional Rescuers and Health Care Providers or American Heart Association Basic Life Support (BLS) for Healthcare Providers
ICS 100
NIMS700
PHTLS/ITLS
CEVO III
HAZMAT Awareness
Blood Borne Pathogens
New Jersey State Drivers License

Select the Role you are applying for

Select the role you are applying for *Please select your role correctly as the application is customized per role.Volunteer – EMS Responder (EMT/Ambulance Driver)Volunteer – Cadet (Members under 18 years old)Volunteer – Associate (Administrative/Non-Responder)Employee – Per Diem EMT

Personal Information

Name *

Date of Birth *

Home Address

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal code *

Mailing Address

Same as Home Address

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal code

Contact Info

Cell Phone Number *

Home Number

Email Address *Please avoid school/temporary e-mail addresses when possible

Confirm Email Address *Please avoid school/temporary e-mail addresses when possible

Emergency Contact

Name *

Relation *

Phone Number *

Education

High School

School/Program Name *

City *

State/Province

Country

HS Enrollment Status *

Anticipated Completion Year *

Completed Year *

Have you ever studied at a college/unversity/trade school? *

Post-Secondary Education

School/Program Name

City *

State/Province

Country

Program Enrollment Status *

Anticipated Graduation Year *

Certification/Degree Obtained

Additional education notes

Availability

Volunteer Shift AvailabilityIndicate the times you may be available to serve an ambulance shift

Nights 6:00 PM- 10:00 PMMondayTuesdayWednesdayThursdayFridayRotating Saturdays 24 hrs (every 6 weeks)

Nights 10:00 PM – 6:00 AMMondayTuesdayWednesdayThursdayFriday

Sunday6:00 AM – 12:00 PM12:00 PM – 6:00 PM

Rotating 24 hr SaturdaysYes

Other availability

Per Diem EMT Availability

Shift and Availability Submission Conditions *

- Per Diem EMT shifts run weekdays from 5:45AM to 6:00PM
- Shifts may run past 6:00PM due to late calls/operational reasons
- You must submit a minimum of 4 shift days of availability per month. The organization goal is to assign at least 2 shift days submitted.

I agree that I have read and understand these conditions.

Certifications and Licenses

At a minimum, submit the following certifications/licenses:

New Jersey EMT Certification
American Red Cross CPR/AED for Professional Rescuers and Health Care Providers or American Heart Association Basic Life Support (BLS) for Healthcare Providers
ICS 100
NIMS700
PHTLS/ITLS
CEVO III
HAZMAT Awareness
Blood Borne Pathogens
New Jersey State Drivers License

Active CertificationsEnter all active certifications you currently hold. For Per Diem EMT applications you must include all required certifications while applying.

Certification Name

Valid From

Valid To

Document Number (If applicable)

Upload Certificate Image

No file chosen

Drivers License / History

Do you possess a valid NJ State Drivers License *Operation of Squad vehicles requires a New Jersey Drivers License per Sparta Township regulations.

New Jersey Operator

NJ Drivers License Number *

Upload Drivers License Image *

No file chosen

Have you ever held a drivers license outside New Jersey?

Other Drivers LicensesList all other drivers licenses outside New Jersey

State/Province

Country

From Year *

To Year

Have your driving privileges ever been revoked or suspended in ANY jurisdiction? *

If "Yes" provide details

Have you ever been issued a motor vehicle summons in ANY jurisdiction? *

If "Yes" provide details

Have you ever been convicted of a DWI or DUI in ANY jurisdiction? *

If "Yes" provide details

Have you ever been involved in a motor vehicle crash as an operator which resulted in any personal injury or property damage in ANY jurisdiction? *

If "Yes" provide details

Experience and Background History

Criminal History

Have you ever been convicted of a felony or under indictment at this time? *

If "Yes" provide details

Criminal History

Have you ever been convicted of a felony or under indictment at this time? *

If "Yes" provide details

Previous Work/Volunteer Experience

Organization Name *

Position *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal code

Country

Supervisor Name *

Phone Number *

Start Date *

End Date

Job Type *

Pay Rate $ *

Select *

Reason for leaving

Associate Membership

Provide a list of skills/experiences that would benefit the administrative operations of the Squad

References

Reference ListPlease list a total of 3 references below, with one being a professional reference (cadet applicants excluded).

Relationship Type *

Name *

Phone Number *

Email Address

Relationship to you *

Known how many years *

Cadet Membership

Program Overview

The Cadet program was established so high school students can gain experience in emergency medical services, while providing service to the community. Cadets respond to calls, treat patients under the supervision of EMT’s, attend trainings and meetings, and are active members of the Sparta Ambulance Squad, supporting its projects and endeavors.

The Sparta Ambulance Squad accepts applicants for cadet membership only with permission of the applicant’s parent or guardian.

Upload a copy of your last report card or a letter from a guidance counselor of proof that you maintain a “C” or greater average in all classes. *

No file chosen

Cadet AvailabilityParent/Guardian – indicate your child’s allowed participation schedule

School Nights 2:30pm – 6:00pmYesNo

School Nights 6:00pm – 10:00pmYesNo

Weekends 6:00am – 10:00pmYesNo

Specify any schedule restrictions (if any)

Cadet Acknowledgements

Cadet certification commitment *

To be accepted by the cadet:

I agree to complete my Healthcare Provider or BLS CPR certification prior to starting training, as well as complete the EMT course within two (2) years of my
acceptance date.

Parental risk consent *

To be accepted by the parent/guardian:

I acknowledge that participation in the Sparta Ambulance Squad Cadet Program involves exposure to emergency medical environments, including physical activity, lifting, loud noises, distressing sights, strong language, and other risks, including the risk of physical and emotional injury.

I understand Sparta Ambulance Squad has policies, training, supervision, and safety measures designed to limit exposure and protect participants, but these measures cannot eliminate all risks or guarantee safety.

I have read and understand these risks and consent to my child’s participation.

Parental Emergency Medical Authorization *

To be accepted by the parent/guardian:

In the event of an emergency, I authorize organization staff to obtain medical treatment for my child and to transport my child to a medical facility if necessary.

Parental Consent *

To be accepted by the parent/guardian:

I grant permission for my son/daughter to apply for cadet membership of the Sparta Ambulance Squad.

Acknowledgments

Legal Authorization to Work in the United States *

I attest that I am legally authorized to work in the United States and will provide required documentation upon request.

Essential Job Function Agreement *

Emergency medical responders must be able to perform physically demanding and emotionally challenging tasks. These include lifting and moving patients and equipment, working in high‑stress environments and time‑sensitive situations, and regularly encountering traumatic injuries, intense scenes, and strong language.

I agree that I am able to safely and effectively perform these essential functions, with or without reasonable accommodation.

Accuracy of Application *

I agree that the information I have provided in this application is true and complete to the best of my knowledge and that I understand that errors, omissions, or false statements may result in disqualification or termination of my application, employment or membership.

Authorization for Records Checks and Release *

I authorize Sparta Ambulance Squad to obtain and verify information about me, including driving records, criminal history, and other background information from third parties.

I understand that Sparta Ambulance Squad will conduct any required individualized assessment under applicable law and, if these records are relied upon to take adverse action, will provide written notice and a reasonable opportunity to respond prior to making a final decision.

I release those third parties from liability for providing such information and release Sparta Ambulance Squad from liability for relying on the information obtained.

Consent to Third‑Party Handling and Storage *

I understand that third‑party vendors or agencies may handle, store, or process my background check information.

I consent to such handling for the purpose of verifying my eligibility and understand that absolute confidentiality and safety cannot be guaranteed.

Consent to Contact References *

I authorize Sparta Ambulance Squad to contact the references and previous employers I have listed for the purpose of evaluating my application.

I understand that if I request certain references or employers not be contacted, that request may affect the evaluation or final determination of my application.

(Optional) References not to contact

Electronic signature consent *

I agree to sign documents electronically. I understand that an electronic signature has the same legal effect as a handwritten signature.

Electronic signature forms include: a typed name, drawn signature, or signature applied through an electronic signature service.

I authorize Sparta Ambulance Squad to send me documents electronically, and I agree that signed electronic documents may be stored instead of paper copies.

Applicant Signature

Applicant Signature *

Start signing your signature here

Parent/Guardian Signature *Parent/Guardian, by signing you consent to your child joining the Cadet Program.

Start signing your signature here

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