INSERT YOUR TEAM NAME HERE

Application for Membership

PERSONAL INFORMATION
Last Name:						Given Names:
Address:						Telephone (Home)
			Postal Code:			Telephone (Work) Cell:
Date of Birth:						Sex: M___________ F___________
Email Address: Valid Drivers License #
Height:		Weight:					Eye Colour:			Hair Colour:
Physical and/or Medical Conditions/Restrictions: (Which may restrict you from field exercises but does not restrict membership)
EDUCATION, CREDENTIALS, INVOLVEMENTS
Education	Highest grade or level completed							Type of Graduation Diploma
Other qualifications	Name of Program								Length of Program
	License, Certificate, Diploma, or Degree awarded Yes No								Details
Other qualifications	Name of Program								Length of Program
	License, Certificate, Diploma, or Degree awarded Yes No								Details
List any Work Related Skills which you feel are applicable to SAR:
List any other Hobbies, Qualifications which you feel are applicable to SAR:
REFERENCES: (excluding personal friends and relatives)
NAME and OCCUPATION					ADDRESS						TELEPHONE
											Home
											Work
											Home
											Work
											Home
											Work
											Home
											Work
EMPLOYMENT
PRESENT EMPLOYER:
ADDRESS								TELEPHONE
								FAX
DOES YOUR EMPLOYER AGREE WITH YOU JOINING THE SEARCH & RESCUE TEAM? YES NO Does your employer have a policy in place should you be required to leave your work station to attend a SAR incident? YES NO
AUTHORIZED SIGNATURE OF EMPLOYER:
SIGNATURE:				PLEASE PRINT:					DATE:
AUTHORIZATION FOR POLICE CHECK I AUTHORIZE THE INSERT YOUR TEAM NAME HERE EXECUTIVES TO REQUEST THE POLICE TO CHECK THEIR RECORDS ON ME, AND TO ADVISE SUCH EXECUTIVES AS TO APPROVE OR NOT APPROVE MY APPLICATION FOR MEMBERSHIP. ALL INFORMATION COLLECTED WILL REMAIN CONFIDENTIAL. SIGNATURE: DATE:
PLEASE WRITE A BRIEF DESCRIPTION WHY YOU WOULD LIKE TO JOIN INSERT YOUR TEAM NAME HERE; AND WHAT ARE YOUR EXPECTATIONS? WOULD YOU BE INTERESTED IN SERVING ON THE BOARD OR COMMITTEES? YES___NO___
I HEREBY DECLARE THAT THE FOREGOING INFORMATION IS TRUE AND COMPLETE. I UNDERSTAND THAT A FALSE STATEMENT MAY DISQUALIFY ME FROM MEMBERSHIP WITH INSERT YOUR TEAM NAME HERE OR RESULT IN DISMISSAL. IT IS UNDERSTOOD AND ACCEPTED THAT I AM INVOLVED IN A COMPETITIVE RECRUITMENT SELECTION PROCESS AND THAT MY OFFER FOR MEMBERSHIP MAY BE DECLINED AT ANY PROCESSING STAGE. I ALSO UNDERSTAND THAT THE OPPORTUNITY FOR MEMBERSHIP WITH INSERT YOUR TEAM NAME HERE WILL BE BASED SOLELY ON MERIT AND ON NO OTHER CONSIDERATIONS.
APPLICANT SIGNATURE:								DATE:
RETURN APPLICATION TO:
INSERT YOUR TEAM NAME AND ADDRESS HERE

APPLICATION 2004-01