Volunteer Application Form Volunteer Application Name * Nickname * Primary Phone: * Secondary: Email * Address * City * Zip * Date of Birth * Social Security Number: * Gender: * Male Female Race: * American Indian or Alaska Native Black or African American Native Hawaiian or Other Pacific Islander Asian Hispanic or Latino White Emergency Contact: * Phone: * Preference for Volunteer Service: * EM EMR Driver Front Desk Cook Dispatch Information Technology Wheelchair Maintenance Vehicle Maintenance Do you reside in the area full-time? * Yes No Months you reside in area * Previous Occupation(s) * Have you previously applied to or volunteered at the Squad? * State(s) of residence in last five years: * Have you ever been arrested/convicted of a crime? * Have you ever been convicted of a felony? * Do you have any physical limitations or medical problems which would impact your participation on the Squad? If so, what type? * I give permission to you to check my driving record and to do a background check. I attest that I do not use any illegal drug and that I will at no time perform Squad duties after consuming alcohol or any substance (including medications) that might lessen my ability to respond appropriately. * Yes No Submit If you are human, leave this field blank.