Deer-Grove EMS

DGEMS Volunteer Application

Deer-Grove EMS (DGEMS) is a premier provider of pre-hospital care in the Dane County region of Wisconsin. Our service relies on a unique combination of full-time, part-time, intern and volunteer staff to achieve high level service to the citizens and visitors of our district. Please fill out this application, which will be forwarded to our coordinator. Please fill out the entire application before submitting your application.

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

Personal Information
First Name:		Your first name is required
Last Name:		Your last name is required
Street Address:
City:
Zip Code:
Home Phone Number:
Cell Phone Number:
Email Address:		A valid email address is required

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 This must be checked to Submit