VOLUNTEER CONFIRMATION |
It is a crime for any person knowingly or willfully
to provide
false information on this application, or make deliberately
misleading
statements regarding the eligibility of applicants.
[N.J.S.A. 2C:21-4(s)].
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| * NJ EMT-B Certification Number |
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| * NJ EMT-B Expiration Date |
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| * Volunteer Squad Name |
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| * Training Officer Name |
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| * Volunteer Squad Address |
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| * Volunteer Squad Phone Number |
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