DEER GROVE EMERGENCY MEDICAL SERVICE

Serving the Villages of Cottage Grove and Deerfield, the Town of Cottage Grove, and surrounding areas in Dane County, Wisconsin

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Volunteer ApplicationDecember 11, 2017

Are you looking for a new opportunity, thinking about giving back to the community, or looking for high quality training with opportunities to grow? Whether you are already a licensed medical professional (EMT, PA, RN, etc.) or not medically trained but interested in helping out, Deer Grove EMS needs you!

Deer Grove EMS can offer you the ability to volunteer at any level of EMS care (EMT through Paramedic) with the use of high quality equipment, training with opportunity to advance, uniforms, stipend, and social events with great people to know and learn from.

Before filling out the application below, please read our volunteer information sheet, located here - volinfo.pdf

Personal Information

First Name:
Last Name:
Street Address:
City:
Zip Code:
Home Phone Number:
Cell Phone Number:
Email Address:
Are you at least 18 years old?



EMS Information

Level of Licensure:
WI EMT License Number:
Nationally Registered EMT:
NREMT Number:
CPR/CCR Trained:
CPR/CCR Expiration:
CEVO/EVOC Certification:
CEVO/EVOC Expiration:



Additional Information

Do you live in our district:
Do you work in our district:
Do you have a valid WI DL:
How did you hear about us:
Why would you like to be a volunteer with DGEMS:
I read and understand the volunteer guidelines posted above