Tri-Community Ambulance 

Proudly serving the residents of the Bergholz, Pekin, Sanborn and St. Johnsburg Fire districts since 1956!

Online Application 

Online Application Disclaimer: 

By submitting this online application you are agreeing to the following

I hereby represent and warrant that the answers to the below questions are true and correct and are given the purpose of securing the active/junior membership with Tri-Community Ambulance Service, Inc. If my application is approved, I hereby agree to abide by the constitution, and Bylaws, and  Standard Operating guidelines of Tri-Community Ambulance. This application must be approved at the regular monthly membership meeting following the receipt of this application. 

I also certify that I have never been charged or convicted of a felony. Failure to be truthful will be grounds for immediate dismissal. I authorize Tri-Community Ambulance Service, Inc. to obtain an investigative criminal record search, motor vehicles records search, and registered sex offender search before membership is granted and any time during my membership. This investigation is completely confidential. I hereby hold Tri-Community Ambulance Service, Inc. free and harmless of any liability for any damages arising out of any improper use of this information. 

I certify that my answers are true and complete to the best of my knowledge. If this application leads to membership, I understand that false or misleading information in my application or interview may result in my dismissal from the company. 

I understand that there is a $10.00 application fee payment can be made via mail to P.O. Box 241 Sanborn, NY 14132 or via VENMO @TriCommunity-Ambulance or you can setup payment arrangements during my phone interview. 

I also understand that I will need to provide a letter of recommendation from any fire/ambulance company that I have or currently belong to. If you are unable to get a letter of recommendation please provide reason why letter was not able to be received.

I also understand that Tri-Community Ambulance is a volunteer organization however standards are very high and require members to conduct themselves as professional. I also understand that I am required to give 12 hours of service a month. 

Thank you for submitting your application for membership. We will be in contact with you as soon as possible for a phone interview.
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