Search and Rescue Volunteer Application

First Name:

Last Name:

Street:

City:

State:

Zip Code:

How long have you lived in this city?:

Phone:

Work or Cell:

Fax:

Date of Birth:

Email:

Do you communicate through texting?:

How did you learn about this volunteer position
(i.e., newspaper, Holisso, CN Home Page, Internet, employer, friend)?:

Why are you interested in becoming a Chickasaw Nation Search and Rescue or CERT volunteer?:

Have you been, or are you, a volunteer of a FIRE, SAR or CERT group?:

If yes, list:

Do you belong to any other volunteer organizations?:

If yes, list:

We look for special skills and qualifications related to search and rescue and/or enjoying the outdoors and/or community work through your jobs or volunteer positions including first aid, map and compass, CLASS 1 driver's license. Please list your skills or talents that you feel may compliment this program:

List any fundraising experience and/or fundraising projects or programs in which you have been involved:

List any committee or board work you have done through work or volunteer positions:

List local areas of which you have good to excellent knowledge including parks, reserves, forests, etc.:

List the personal outdoor equipment you already have:

List any specialized trainings related to search & rescue you have acquired (including tracking, deep sea certification, medical/fire training, etc.):

Employment

Current Position:

What hours do you work?:

Supervisor's Name:

Supervisor's Number:

Have you spoken to your supervisor about joining SAR?:

Does he/she support you?:

Would you be allowed time away from work at anytime?:

Do you want to volunteer only on your off-duty hours?:

Do you have medical issues?:

If yes, list any problems that would affect your ability to perform in an outside environment:

If you wish to describe any further skills, training, education, and/or interests that you feel are possibly relevant to the search and rescue volunteer position, please feel free to use this space:

References

Name:

Relationship:

Phone Number:

Email:

Name:

Relationship:

Phone Number:

Email:

I hereby give the Chickasaw Nation Search & Rescue my consent to contact the above references regarding this application, if necessary. I have contacted these references and confirmed their willingness to provide a reference for me and the above information.

I acknowledge that the Chickasaw Nation Search & Rescue is under no obligation to accept me as a volunteer.

Please enter your initials if you agree to these statements:

Participation in the SAR team requires a minimum of 50 percent of training attendance/participation and involvement in missions and/or Chickasaw Nation community events. This includes six of 12 monthly meetings. For specifics on trainings, please contact Chickasaw Nation Search & Rescue.