EmailMe Form - Thomasville Rescue Squad, Inc.

APPLICATION TYPE *

RESCUE

ASSOCIATE (U.S.A.R)

AUXILIARY

Applicant's Name *

Please give your FULL legal name.

Applicant's Social *

###-##-####
*This number will be kept private and is only for insurance and Department files.

Applicant's DOB *

MM/DD/YYYY

Applicant's Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Phone *

### - ### - ####

Please list phone number you may be reached at.

Email *

Please list an email you actually check.

Confirm

APPLICATION PROCEDURE:

1. Obtain and fill out application at any meeting or online.
2. Attach copies of any certifications.
3. Within the application process, attach a background check for all counties in which you have lived for the past (5) years.
4. Within the application process, attach a driving record for all states you have been issued a driving license for the past (5) years.
5. ATTEND THREE CONSECUTIVE REGULAR SCHEDULED SQUAD MEETINGS (2nd & 4th TUESDAY)
6. At the third meeting, the Officer's Council will review applicant's application, and with a favorable recommendation, will grant a PROBATIONARY MEMBERSHIP status to the applicant.
7. The PROBATIONARY MEMBERSHIP status is for one (1) year. The Probationary Member MUST obtain the Hazardous Materials Operation Certificate and MUST have completed the minimum of Emergency Medical Technician Basic. At the end of the probationary year, the Officer's Council, with favorable reports from the Training Coordinator, may grant full Senior Membership status to the probationary member. The probationary status may be extended through the end of the Emergency Medical Technician Basic and/or Hazardous Materials Operation certification processes if needed.

EDUCATIONAL EXPERIENCE:

School / Year / Outcome (Diploma, Certificate, Degree, etc.): *

CERTIFICATIONS: *

Certification / Completion Date / Expiration Date

YOU MAY UPLOAD CERTIFICATES / DOCUMENTS HERE:

Only (1) file may be uploaded at a time.

Why do you wish to volunteer for the Thomasville Rescue Squad? *

List past experiences that may be beneficial as a member of the Thomasville Rescue Squad *

REFERENCES: (Please List 3 References)

Name / Phone # / Length of Time Known / In what capacity do you know this person? *

EXAMPLE:
Name
Phone #
Length of Time Known
In what capacity do you know this person?

Name / Phone # / Length of Time Known / In what capacity do you know this person? *

EXAMPLE:
Name
Phone #
Length of Time Known
In what capacity do you know this person?

Name / Phone # / Length of Time Known / In what capacity do you know this person? *

EXAMPLE:
Name
Phone #
Length of Time Known
In what capacity do you know this person?

If accepted as a member, I understand that I will not receive any monetary compensation for my involvement. I will attend two-thirds (2/3) of the meetings every quarter, volunteer a minimum of 12 hours per month (to include building duties, Standy-bys, etc.) and attend a minimum of thirty-six (36) hours of training and drills as required by the North Carolina General Statutes to maintain benefits.

I agree with the terms and conditions listed above. *

Yes

No

DIGITAL SIGNATURE *

This "Electronic" Signature hereby stands as my written signature for all legal purposes.

Date Time *

MM / DD / YYYY HH : MM AM/PM