POD and PWOEM Volunteer Application

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 PWOEM, please fax this application back to (516) 320-8014.  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 PWOEM are desired as well.

Name: ________________________

Address: ________________________

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) 320-8014 or email us at info@pwoem.org