Volunteer Application Form First Name * Last Name * Cell Phone: * Email * Address * City * Zip * Date of Birth * Social Security Number: * Gender: * MaleFemale Race: * —Please choose an option—American Indian or Alaska NativeBlack or African AmericanNative Hawaiian or Other Pacific IslanderAsianHispanic or LatinoWhite Emergency Contact: * Phone: * Preference for Volunteer Service: * —Please choose an option—EMEMREMTDriverFront DeskCookDispatchInformation TechnologyWheelchair MaintenanceVehicle Maintenance Do you reside in the area full-time? * YesNo If not Full Time, What months do you reside in this 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. * YesNo
