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Emergency Volunteers

 Application For Emergency Volunteer

If you would like to be considered to serve as a volunteer before, during or after an emergency situation please complete the form below. Interviews will be scheduled with applicants being considered.

 

First Name Last Name
Are you over 18 years of age? yes    no
Company Name
Profession
Phone
Fax
Cell Phone
Pager
Email
Address
City/Town Zip Code
Next of Kin1 Phone1
Next of Kin2 Phone2
Do you have any medical problems? yes    no
     If yes, please explain
Do you have any allergies? yes    no
     If yes, please list
Do you have any restrictions? yes    no
     If yes, please list
Do you have your own transportation? yes    no
Do you have volunteered previously? yes    no
     If yes, what role did you play?
Do you own a 4wheel drive vehicle? yes    no
     Make
     Model
     Year
     How many people does it fit
               (in addition to you)
Do you own a CB radio? yes    no
Do you own a Marine radio? yes    no
Are you certified in CPR? yes    no
Are you certified in First Aid? yes    no
Are you certified as an EMT? yes    no

Red Cross Training will be provided for individuals selected.
Are you available during an event...
      check all that apply
     7:00 a.m. - 3:00 p.m.
     3:00 p.m. - 11:00 p.m.
     11:00 p.m. - 7:00 a.m.
Are you available prior to an event to assist with the setup? yes    no
Are you available after the event to assist with the cleanup? yes    no
Will someone else be coming with you? yes    no

   1st person - Name

Age -
 if under 18

   2nd person - Name

Age -
 if under 18

   3rd person - Name

Age -
 if under 18

Do we have your permission to perform a BCI check? 
(background criminal investigation)

 yes    no
Position Preference 1  
                          position descriptions
Position Preference 2
                          position descriptions
Position Preference 3                          
                          position descriptions


Training will be provided for individuals selected.

  

 

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