Mountainside Rescue Squad, Inc.

Online Application for Membership

Name_____________________________________________  Date of Birth_______________
Address___________________________________________   Phone #__________________
             ___________________________________________   Email____________________
Place of Employment___________________________________________________________

                                    (Company or school, name and address)
Business Phone #____________________________________
Drivers License #____________________________________ Expiration Date______________
FIRST AID TRAINING
Name of Course                                    Date of Course                         Taken Where
___________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

REFERENCES (List 2 persons that have known you for more than two years, and are not relatives)

Name                                                   Address                                       Phone #
____________________________________________________________________________
____________________________________________________________________________
Have you been a member of any other rescue squads?  If yes, give name of squads, dates of membership, and reason for leaving.               

When are you available for duty?  Days____________________________________________
                                                    Evenings_________________________________________
                                                    Weekends________________________________________

        I hereby certify that all of the above information is correct.  I understand that this application will be reviewed by the Board of Directors of the Mountainside  Rescue Squad.  I understand that they will contact my references and check my drivers license.  I understand that any falsifications on this applications or in my interview will prevent my acceptance as a member or be cause for immediate expulsion if found after my acceptance.  If accepted I agree to uphold the by-laws and any other rules and regulations of the Mountainside Rescue Squad.

Signature                                                                                           Date___________________

(IF UNDER 18. signature of parent or guardian is required)

Signature of parent or guardian                                                            Date__________________

This application will be reviewed by the Board of Directors of the Mountainside Rescue Squad.  Each applicant will be interviewed by the Board at the next Board meeting.  The Board will check out all information on this application.  The applicant will be informed of the decision of the Board within one month of their interview.
 

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