Membership/mutual aid application

An application must be completed for each individual member or mutual aid application
*disclosure: all questions are to be answered at the will of the applicant, if uncomfortable in releasing any medical or background information, please state so.

Type of membership applying for:

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone

(###)

###

####

DOB

YYYY

D/L #

Employer

Employer Phone

(###)

###

####

Position

Would your employer allow you time off for emergency assignments?

Please describe.

Emergency Contact 1 Name

First Name

Last Name

Emergency Contact 1 Relationship

Emergency Contact 1 Phone Number

(###)

###

####

Emergency Contact 2 Name

First Name

Last Name

Emergency Contact 2 Relationship

Emergency Contact 2 Phone Number

(###)

###

####

Physician

Physician Phone

(###)

###

####

Dentist

Dentist Phone

(###)

###

####

Medical conditions or allergies

Please list any medical conditions or allergies

Do you take medications that may alter your driving, speed, or slow your physical response or noted side effects in any way that could alter your working or normal activities?

Please describe.

Do you have any medical training or experience?

Please describe.

Do you have any dog training experixperience?

Please describe.

Have you had training in any of the following:

HazMat

SAR TECH

CPR

Incident Command

First Aid

Canine First Aid or Vet Tech

UAV (unmanned aerial vehicle) FAA Drone Compliance license

List any additional training or experience that you have that would be helpful in SAR:

Please list any criminal or civil infractions:

Applicant Statement

I hereby apply for membership with the Southwest Florida K-9 Search Unit. I state that I am not addicted to any un-prescribed controlled substances, nor have I been convicted of a felony. The signing of the application constitutes my permission for the Southwest Florida K-9 Search Unit to obtain a current copy of the background check I obtain from the FBI. If accepted for membership to the unit I agree to follow all rules, regulations, and by-laws. I agree to provide a FBI background check current to application date, I agree to follow team Standard Operating Guidelines and Team Bylaws. Instructions for FBI fingerprint instructions (please refer to welcome letter) or go to www.fbi.gov, on the left side choose fingerprints, go to requesting your fingerprints rap sheet, follow instructions at "how to request a copy of a record." I certify that all information on this application is true. I understand that giving false statements are grounds for dismissal from the unit.

By typing my name below I understand that my typed name signifies agreement and acknowledgement of the terms and conditions of this document.

Today's Date

YYYY

If you are applying as a K-9 handler, a current copy of your dog's vaccinations must also be emailed to the board of directors.