Davis County Sheriff Search & Rescue

DAVIS COUNTY SHERIFF SEARCH & RESCUE Volunteer Interest Form

FIRST NAME MIDDLE LAST NAME

STREET ADDRESS CITY ST ZIP CODE

MAILING ADDRESS (If Different) CITY ST ZIP CODE

HOME PHONE ( ) - WORK PHONE ( ) - CELLULAR PHONE ( ) - PAGER/OTHER ( ) - SOCIAL SECURITY # DATE OF BIRTH PLACE OF BIRTH (City, State) ARE YOU A U.S. IF NO, LIST NATIONALITY/TERMS OF LEGAL

CITIZEN? RESIDENCY. Education / Training History: EDUCATION / TRAINING MAJOR SUBJECT / COURSE OF DATES FROM / DEGREE/CERTIFICATION INSTITUTION STUDY TO ATTAINED

References (Please do not list relatives or former employers) NAME OCCUPATION ADDRESS CITY ST ZIP TEL ( ) - ( ) - DO YOU KNOW A MEMBER OF THE DAVIS COUNTY SHERIFF’S SEARCH & RESCUE? WHO?

WHY ARE YOU INTERESTED IN BECOMING A SEARCH & RESCUE VOLUNTEER?

LIST ANY PROFESSIONAL LICENSES OR CERTIFICATIONS YOU HOLD THAT MAY BE USEFUL IN SEARCH & RESCUE (NURSE, EMT, POST):

LIST ANY SPECIAL SKILLS YOU POSSESS THAT MIGHT BE USEFUL TO SEARCH AND RESCUE:

LIST ANY SPECIAL EQUIPMENT YOU POSSESS THAT MIGHT BE USEFUL TO SEARCH AND RESCUE:

In the space provided below, please elaborate on the contribution you feel you can make to Search & Rescue. You may also wish to note any additional information that would be helpful in evaluating your qualifications.

I hereby certify that to the best of my knowledge the information provided on this form is true and correct. If accepted for membership in the Davis County Sheriff’s Search and Rescue, I agree that all material created and produced, whether in written, graphic or broadcast form, and all inventions and processes developed as part of my membership in this organization are the exclusive property of the Davis County Sheriff’s Search and Rescue to use and/or sell for the benefit of the organization. I understand that as a member of the Davis County Sheriff’s Search and Rescue I may have access to privileged and/or confidential information relating to the Davis County Sheriff’s Office, the Davis County Sheriff’s Search and Rescue, or criminal activities investigated by such. I agree to not disclose, use or reveal any such information without first obtaining written consent from the Davis County Sheriff’s Office. (continued on other side)

DAVIS COUNTY SHIERIFF’S SEARCH & RESCUE, VOLUNTEER INTEREST FORM 08/10/1999 – REV A. PAGE 1 OF 2 I understand that, if accepted, my membership in this organization is wholly voluntary, and that no monetary compensation will be given for my services. I also understand that due to the physical nature of the services provided by the Davis County Sheriff’s Search and Rescue, in the course of my duties as a member of such I may be placed in positions of physical danger, and agree not to hold either the Davis County Sheriff’s Office, the Davis County Sheriff’s Search and Rescue, or any members or affiliates of such organizations liable for damage that may occur to my personal property or injury or death of my person.

I hereby apply for membership upon the basis and understanding that such membership may be terminated at any time upon notice given to me personally or sent to my last known address. In such an event, I also agree to return any equipment issued to me personally which may belong to the Davis County Sheriff’s Office or the Davis County Sheriff’s Search and Rescue.

______/____/____ Signature of Applicant Date

DAVIS COUNTY SHIERIFF’S SEARCH & RESCUE, VOLUNTEER INTEREST FORM 08/10/1999 – REV A. PAGE 2 OF 2