THIS APPLICATION IS AVAILABLE HERE FOR FILLING OUT ONLINE

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If you are interested in applying for a volunteer position at the Port Washington Point of Dispensing (POD) or in general with the PWMOEM, please fax this application back to (516) 717-0001.  You may also email us at info@pwoem.org.

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POD training is expected to be once a year; although probably additionally during start-up phase.  You would be expected to help staff the POD if Nassau County were to declare a health emergency.  In addition to medical skills, there are many other skills that are needed. General volunteers for the PWMOEM are desired as well.

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Name: ________________________

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Address: ________________________

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Village:  _________________________

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Home Phone: ________________________

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Cell Phone: ________________________

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Work Phone: ________________________

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Email: ________________________

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Occupation/work training: ________________________

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In which County/Boro do you work? (circle one):

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Nassau, Suffolk, Queens, Brooklyn, Manhattan, Bronx, Westchester, NJ, Other

 

Besides English, what languages do you speak fairly fluently? ___________

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What medical training, if any, do you have? _________________________

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_____________________________________________________________

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What security background, if any, do you have? ______________________

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Other skills that you wish to make us aware of? ______________________

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____________________________________________________________

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Please fax this application back to (516) 717-0001 or email us at info@pwoem.org