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Please Fill Out the Information Below
and Mail to: Clifton Forge Rescue Squad Application for Membership Full Name Age Date SSN - - Address Telephone(H) (W) Occupation Work Schedule Are you able to answer calls from work? ( ) Yes ( ) No Married ( ) Yes ( ) No Spouse's Name (if Yes) # of Children Ages Virginia Drivers License # Reason for Requesting Membership-
Training and/or Experience-
Have you ever been convicted of a Felony or Misdemeanor, other than a parking ticket? If yes, Explain- Have you ever been rejected or dismissed from any other organization? If yes, Explain-
The undersigned, understand that my application will be placed under investigation by the rescue squad and will be brought to the floor of the rescue squad at the following business meeting. The squad, as a whole, will then vote on my application. Upon acceptance to the rescue squad, I will be placed under the status of trainee member for 6 months and I will remain in this class until I complete and pass a Virginia EMT Program. Also, I know that as a trainee member I cannot run for office and do not have a vote. Upon successful completion of the EMT program I will move up to Probationary Member and will serve a minimum of 6 months in this class and will not have a vote and cannot run for office. I understand that I will take part in all squad activities that my health and availability permits, without sacrifice to my family, occupation, and or home. I will conduct myself under the rules set forth by the Clifton Forge Rescue Squad and obey all instructions and regulations to the best of my ability. Applicants Signature I have applied for membership in the Clifton Forge Rescue Squad, Inc. I authorize my family and acquaintances to give any information they have concerning me to the membership committee and to the representatives of the rescue squad. I hereby release anybody who gives this information from any liability that might otherwise result in termination of my application. Applicants Signature ----------------------------------------------------------------------------------------------------------------------- Committee Use Only Date Received__________ Date Investigated__________ Interviewed By_______________ Recommendation of Committee__________ Squad Vote Date__________ Accepted ( ) Yes ( ) No
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