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Membership Application

Please complete this application to start the process of joining Rehoboth Ambulance

Thank you for your interest in Rehoboth Ambulance!

Please complete the application and a member of our Memberhsip Committee will be in contact with you regarding next steps.

If you are applying as an EMT or Paramedic, please be aware that Rehoboth Ambulance has the folloiwng requirements:

  • You must work a minimum of 24 hours per month to remain active
  • You are expected to submit availability for at least one night per month. You may or may not be schedueld for that night based on overall availability submissions from the rest of the staff
  • You are expected to work your night shifts more often then trying to trade or give them away
  • If you are unable to meet these requirements, but still wish to apply, please discuss your concerns during the interview
Emergency Contact 1
Emergency Contact 2
Education Name of School Course of Study Degree/Certificate Date of Graduation
High School
EMS Training (highest level)
Other education
Name Phone number Years known How do you know them?

By submitting this application, I affirm that all information contained within is true and accurate. I also affirm my understanding of the following staffing requirements:

  • You must work a minimum of 24 hours per month to remain active
  • You are expected to submit availability for at least one night per month. You may or may not be schedueld for that night based on overall availability submissions from the rest of the staff
  • You are expected to work your night shifts more often then trying to trade or give them away
  • If you are unable to meet these requirements, but still wish to apply, please discuss your concerns during the interview