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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

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    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

    10. Have you ever been involved in domestic violence? ? Yes ? No

    11. Have you ever been involved in or been accused of child abuse or neglect? ? Yes ? No

12. Have you ever committed or aided in the commission of a crime, detected

    or undetected, not previously mentioned? ? Yes ? No

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    If you answered yes to any of the above questions, list and summarize below. Give more details on page 9 regarding yes answers.

    Agency Type of Crime Mo/Yr Details

    CRIMINAL HISTORY CONT’D.

    ? No, I have not experimented with, tried, or come in contact with, any type of illegal drug or narcotic.

    ? Yes, I have experimented with, tried, or come in contact with, illegal drugs or narcotics.

1. Have you ever sold, provided, or given illegal drugs or narcotics to anyone? ? Yes ? No

2. Have you ever grown marijuana or manufactured any type of drug or narcotic? ? Yes ? No

3. Have you or anyone else ever injected an illegal drug or narcotic into your body? ? Yes ? No

4. Do you associate with any person who you suspect uses illegal drugs or narcotics? ? Yes ? No

    If you answered yes to any of the question above, explain on back of page. ? Yes ? No

    5. When was the last time you were present where illegal drugs, narcotics, or other illegal substances were being used?

    Month __________ Year __________

    Type of location: ___________________________________________________________________________

     Circumstances: ___________________________________________________________________________

    EMPLOYMENT

? Employed I am currently employed ? full time ? part time.

     Name of employer: _________________________. I have been employed from _____________

     to present. My job title is _________________________. My duties include: _____________________ _________________________________________________________________________________________________

    ? Unemployed I have been unemployed since _____________. I was last employed by _______________________.

     I worked there from ___________________ to _______________. My job title was _________________________.

     My duties included: _____________________________________________________________________________

     My reason for leaving was ________________________________________________________________________

Have you ever been fired, or asked to resign, from any place of employment? ? Yes ? No

    If yes, explain what job, when and why on page 9.

    4

    MILITARY EXPERIENCE

    Have you ever failed to register for Selective Service or the military draft, when required to do so by law? ? Yes ? No

Have you ever served in the military? ? Yes ? No

    Branch: ___________________________________________________ Highest Rank _______________ Rank on Discharge ______________ Date of service from ______________ to (EAOS date) ______________ What type of discharge did you receive?

    ? Honorable

    ? General, Under Honorable Conditions

    ? Under other than Honorable Conditions

    ? Other __________________________________________________

Are you active in the military reserve or national guard? ? Yes ? No

    Do you have military police training or experience? ? Yes ? No

    Did you ever receive any judicial disciplinary action? (Court Martial, Article 15, Captain’s Mast, Other) ? Yes ? No

    If yes, give summary below and provide more details on back of page 9.

    Type Date Disposition

Other than for security purposes, were you ever the subject of any other type of military

    Investigation? If yes, explain on back of page 9. ? Yes ? No

    LAW ENFORCEMENT INFORMATION

Have you applied with the Tuolumne County Sheriff’s Department SAR before? ? Yes ? No

    If yes, when and for what position(s) ____________________________________

    What was the disposition of the application(s) _____________________________

Have you applied with any other law enforcement agencies? ? Yes ? No

    If yes, list below. List additional agencies on page 9.

    Agency What Year Disposition

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Have you had any Law Enforcement training? ? Yes ? No

? In __________ I completed the P.O.S.T. Police/Sheriff’s Academy at ______________________________________

     Mo/Yr Academy name and location

? In __________ I completed the P.O.S.T. Reserve Level I II - III at _______________________________________

     Mo/Yr Academy name and location

    ? In __________ I completed a California S.T.C. Corrections Academy at ____________________________________

     Mo/Yr Academy name and location

    ? In __________ I completed a Corrections Academy at __________________________________________________

     Mo/Yr Academy name and location

    ? Other training includes ___________________________________________________________________________

     ______________________________________________________________________________________________

Have you had any Law Enforcement experience? ? Yes ? No

    If yes, complete below:

    ? I am currently employed as a ____________ with ______________________________________since ________

     Agency name and location

    ? I was employed as a _____________ with _________________________ from _________to_____________

     Agency name and location_________________________________________. My reason for leaving was_____________

__________________________________________________________________________.

? Other employment includes:

    _______________________________________________________________________________________________

    _______________________________________________________________________________________________

    6

    ORIENTATION ESSAY

The ability to express oneself clearly in writing is extremely important in Search and Rescue. Please

    write a thorough essay stating your reasons for wanting to become a Volunteer with the Tuolumne County Sheriff’s Department Search and Rescue Team. Include any education, training and experiences that you feel may be beneficial. Please type or print.

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    USE THIS PAGE FOR ANY ADDITIONAL INFORMATION

    (attach additional sheet(s) of paper if necessary)

    If you are responding to a question, please write the number of the question.

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    8

    SEARCH & RESCUE INFORMATION CON’T.

Have you ever been the subject of an internal affairs investigation? ? Yes ? No

Have you ever had any type of disciplinary action taken against you ? Yes ? No

    (Verbal, written reprimands, note in file, suspensions?)

Have you ever been allowed to resign in lieu of termination? ? Yes ? No

    If you answered yes to any of the three questions above, explain on page 9.

    I HEREBY CERTIFY THAT ALL STATEMENTS MADE IN THIS APPLICATION PACKET ARE TRUE AND COMPLETE AND I UNDERSTAND THAT ANY DISCREPANCIES, MISSTATEMENTS, OMISSIONS AND/OR FALSIFICATIONS WILL CAUSE MY NAME TO BE REMOVED FROM THE ELIGIBLE LIST, OR BE CAUSE FOR DISMISSAL IF AN APPOINTMENT WAS MADE.

    I HAVE READ THE ABOVE STATEMENT AND PRIOR TO SUBMITTING THIS APPLICATION PACKET, I HAVE REVIEWED IT CAREFULLY FOR ACCURACY.

    SIGNATURE IN FULL ___________________________________________________

DATE ______________________________

    9

    AUTHORIZATION TO RELEASE INFORMATION

NAME: _________________________________________________________________________

    LAST FIRST MIDDLE

OTHER NAMES USED:

______________________________________________________________________

     (AKA’S, PRIOR MARRIAGES, MAIDEN NAMES, ETC)

BIRTHDATE: ____ - _____ - _____ SOCIAL SECURITY NO.: ______________________

To Whom It May Concern:

    As an applicant for a position with the Tuolumne County Sheriff’s Search & Rescue, I am required to furnish information to determine my moral character, honesty, dependability and qualifications. I hereby request and authorize the disclosure of any and all records, files, notes, opinions or other information you may have concerning me, including information of a confidential or privileged nature, to a background Investigation Unit of the Tuolumne County Sheriff’s. This includes, but is

    not limited to, the release of employment files; personnel records; background investigation files; disciplinary records; any and all internal affairs investigations; complaints or grievances files by or against me; training files; adult and juvenile arrest,

    criminal and probation records; driving record; polygraph and psychological examinations, opinions, conclusions and evaluations; military, financial, credit, academic or other records. This also includes photocopies of the above material.

Section 1031.1 of the Government Code has been amended to require employers to disclose employment information relating

    to a current or former employee, upon request of a law enforcement agency. This section also states that no employer shall be subject to any civil liability for any relevant cause of action by virtue of releasing information required pursuant to this

    section.

    I hereby release you, your organization, all persons, agents, representatives, and others from any liability or damage which may result from furnishing the above information. A photocopy of this release form will be valid as an original thereof; even though said photocopy does not contain an original writing of my signature. This release will expire one (1) year after the date signed.

Signature: _______________________________________ Date: ______________

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