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search & rescue application

By Patricia Carroll,2014-08-04 13:43
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search & rescue application

Tuolumne County Sheriff’s

    SEARCH & RESCUE

    VOLUNTEER APPLICATION

Area of Primary Interest (check one)

     ? CanineTeam ? Mounted Team

     ? Swiftwater Team ? Underground Team

     ? Nordic Team ? Technical Rescue Team

     ? Medical Team ? Helicopter Rescue Team

     ? Motorized Unit ? Dive/Recovery Team

Fill in as completely as possible. Type or print clearly.

Name:

    Last __________________________________ First _________________________ Middle ____________________________

    Other names (maiden, prior, aliases, nicknames) _____________________________________________________________

    Date of Birth (MO/Day/Yr) ____________________ Age ________ SSN ________________

    Sex ___ Height _________ Weight ____________ Hair ___________ Eyes _____________

    Address ________________________________ Apt. _____________ City_______________________ ZIP ___________

    Home Phone (____)_______________ Work Phone (____)_______________ Pager (____) _________________

    EMERGENCY CONTACT

Name _________________________________________________________________

    Address __________________________ Apt. _____________ City______________ ZIP ________________

    Home Phone (____) _________________ Work Phone (____) _________________ Pager (____) _________________

    Return completed application to:

    Tuolumne County Sheriff’s Search & Rescue

    28 N. Lower Sunset Dr.

    Sonora, Ca 95370

    Rev: 03/03

    CITIZENSHIP

You must be a citizen of the United States or a permanent resident alien, who is eligible for and has applied for citizenship.

Place of birth _________________________________________________________________________ City/State/Country

Are you a U.S. Citizen? ? Yes ? No

    If naturalized, what year and where? ____________________________________________________________________

    If you are a permanent resident alien, what is your registration number? _________________________________________

Have you applied for citizenship? ? Yes ? No

When did you apply for citizenship? ________________________________

     Mo/Yr

    MARITAL STATUS

? Single ? Married ? Separated ? Divorced ? Widowed

    Number of marriages______ Number of children_____ Number of children living at home ______

Are you child support and/or alimony payments current? ? N/A ? Yes ? No

    If “no” please explain on page 10.

    EDUCATION

? I do not have a high school diploma.

    ? I have a high school diploma. I graduated in __________ from _________________ High School

     Mo/Yr Name of School

     Located in __________________________

     City/State

    ? I have a G.E.D. or California High School proficiency certificate. I received my G.E.D./CHSP in

    ? __________________from _______________________________ located in ____________________________.

     Mo/Yr Name of school/testing center City/State

? I have no college education.

? I have no college degree

    ? I have a college degree(s). I graduated in___________. My degree(s) is/are (circle) A.A., A.S., B.A.,

     B.S., M.A., M.S. degree. I majored in ______________________________________________

     While attending __________________________________________________ College(s)

     Located in ________________________

     City/State

    2

    DRIVING RECORD

1. Do you have a valid California Driver’s License? (CDL) ? Yes ? No

     CDL number ________________________________ Expiration date _______________________________

    2. Have you ever had an out-of state license?

    What state(s)? ________________________________ What years? _________________________________

     Current out-of-state license number ____________________________

    3. Has your license ever been suspended, restricted, revoked, or placed on probation? ? Yes ? No

     If “yes”, explain when and why on page 9.

    4. Other than a parking ticket, how many tickets have you received in the last five years? _____________________

    Explain on page 9.

    5. Do you have any citations or parking tickets that are past due or pending? ? Yes ? No

     If “yes”, explain on page 9.

    6. Have you been involved as a driver in a traffic accident within the last five years? ? Yes ? No

     If “yes”, explain on page 9.

    7. Do you currently have automobile insurance? ? Yes ? No

     Insurance carrier _________________________________

     If “no”, explain why, and how long you have driven without insurance, on page 9.

    CRIMINAL HISTORY

1. Have you ever been detained, questioned, held on suspicion, fingerprinted or taken into custody, by any law

    enforcement agency, for any reason other than a minor traffic ticket? ? Yes ? No

    2. Have you ever been a suspect in any law enforcement investigation? ? Yes ? No

    3. Have you ever been charged with a crime? ? Yes ? No

    4. Have you ever been arrested? ? Yes ? No

    5. Have you ever been in jail? ? Yes ? No

    6. Have you ever been convicted or pled guilty to any crime? ? Yes ? No

7. Have you ever collected unemployment or welfare benefits (including food stamps),

    when you were not entitled? ? Yes ? No

    8. Since you were 18 years old, have you ever shoplifted anything from a store? ? Yes ? No

    9. Have you ever been involved in a fight? ? Yes ? No