VIRGINIA BEACH
DEPARTMENT OF EMERGENCY MEDICAL SERVICES
DUTY FIELD COMMANDER (EMS-5) TEAM

Online Application Form

Generally, the EMS-5 Team Captain will not accept your application unless you meet one or more of the following criteria:

  • Special Ops 5 or a Brigade Chief or higher has asked you to apply;
  • You hold the VBDEMS rank of Assistant Squad Commander or higher;
  • You would qualify as an EMS-5 Preceptor once you meet the time requirement.

Questionaire Item
VBDEMS EMS-5 Policy Eligibility Item Number
Full name:
Street address:
City:
State:
Zip code:
Home phone #:
Work phone #:
Mobile phone #:
Mobile phone service:
Pager #:
Pager service:
Email address:
Have you given at least 5 years of service to VBDEMS? Yes 1
Have you been active with VBDEMS for the entire year prior to submission of this application? Yes 2
Have you submitted a letter (or email) to your Squad Commander requesting consideration for the EMS-5 program? Yes 3
Are you currently certified as a Virginia EMT? Yes 4
Have you taken Vehicle Extrication? Yes 4
Have you taken Basic & Light or the equivalent (such as Rescue Systems)? Yes 4
Have you taken MCI-2? Yes 4
Who is your Squad Commander?
Do you anticipate that your Squad Commander will approve of this application? Yes 5
Who is your Brigade Commander?
Do you anticipate that your Brigade Commander will approve of this application? Yes 5
Do you anticipate that the Deputy Director (EMS-2) will approve of this application? Yes 5
Do you maintain the minimum activity level as defined by the EMS Duty Policy? Yes 6

Comments:

  • If you have feedback about this form, please send it to Kevin Lipscomb, Info Tech Chair, Virginia Beach Rescue Council.
  • By pressing the Submit button, you certify that all of the above is true to the best of your knowledge.  Falsification of any part of this application will be grounds for rejection or removal from the EMS-5 program.

 
$Id: index.htm,v 1.19 2004/02/14 18:16:26 kevinanlipscomb Exp $