PWM OEM l 130 Shore Rd Suite 124 l Port Washington, NY 11050
Tel: (516) 883-0000 l email: info@pwmoem.org
Copyright ® 2013 Port Washington-Manhasset Office of Emergency Management

Copyright © 2017 Port Washington Office of Emergency Management

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THIS APPLICATION IS AVAILABLE HERE FOR FILLING OUT ONLINE

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.

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.

Name: ________________________

Address: ________________________

Village:  _________________________

Home Phone: ________________________

Cell Phone: ________________________

Work Phone: ________________________

Email: ________________________

Occupation/work training: ________________________

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

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

 

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

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

_____________________________________________________________

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

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

____________________________________________________________

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