Department of Emergency Management

Washington County

Department of Emergency Management

Search & Rescue Team

2615 Brink Drive, Fayetteville, Arkansas 72701

Phone: 479-444-1722

Fax: 479-444-1786

Application for WCSAR Membership

Name ______________________________________________________________________________________

Last First Middle

Date______________ Drivers License Number _________________________State of Issue___________

Social Security Number______________________________ Email______________________________

Street Address________________________________________________________________________

City___________________________________________ State_______ Zip_______________________

Mailing Address_______________________________________________________________________

City___________________________________________ State_______ Zip_______________________

Phone Numbers: Home_____________________________ Work________________________________

Mobile_____________________________________ Pager____________________________________

Date of Birth____________________ Place of Birth: City_______________________ State____________

Sex_____________ Height_____________ Weight___________ Eyes___________ Hair______________

Military Branch_______________ Date Entered____________ Stationed___________________________

MOS________________ Date Discharged____________ Type Discharge__________________________

Have you ever used another name?______ List name(s) and give details_____________________________

____________________________________________________________________________________

Have you ever used drugs, other than by a Doctor’s prescription?_______ If yes, give details:_____________

____________________________________________________________________________________

Are you willing to take a drug screening test?__________________________________________________

Have you ever been treated for a psychological condition? _______ If yes, give details:__________________

____________________________________________________________________________________

List any serious health conditions:___________________________________________________________

Are you taking any routine medications? ________ If yes, give details: What, when_____________________

____________________________________________________________________________________

List languages you speak:________________________________________________________________

References: (List two non-relatives, known at least 3 years, who did not write the attached letters of recommendation)

Name Address Phone

____________________________________________________________________________________

List employment for the past six years, current employer first:

Name Street Address Phone Contact Dates

____________________________________________________________________________________

Do you: Own____ or Rent_____ Landlord_____________________ Phone______________________

List residences for the past six years:

Street Address City State Zip Date

____________________________________________________________________________________

Education: High School/Trade/College City & State Did You Graduate? Give Date

____________________________________________________________________________________

Circle the Search & Rescue Discipline you are applying for: Members must designate one primary unit to participate in,

but are welcome and encouraged to cross-train and participate in others.

Ground (includes Cave and Vertical) K-9 ATV

Mounted (Horse or Mule) Logistics/Communication

List any training or experience you have in the above areas (attach copies of certificates, please)

____________________________________________________________________________________

List equipment and gear you own: (If it is Life Support Gear, list Brand Name, Model, and Date of Purchase)

____________________________________________________________________________________

Briefly, why do you want to join the Washington County SAR Team?

____________________________________________________________________________________

Washington County Search and Rescue Team is a volunteer, non-paid organization. Do you have the personal finances and time

to support your participation in this organization? New members must satisfy a six-month probationary period with strict training and attendance

requirements in their primary discipline. All members must also receive, at a minimum level, Wilderness First Aid/CPR and SAR Technician II Certifications

the first year, at their own expense but offered through WC SAR.

Each unit conducts a monthly evening meeting. Team trainings are held the 3^rd weekend of each month. Members are to be available from

6pm on Friday to 6 pm on Sunday of every 3^rd weekend. We are an all weather Team and train regardless of weather conditions.

Team members are expected to provide their personal equipment and their own transportation to all meetings, trainings and call outs.

Equipment may be acquired, at the member’s expense, during ongoing association with the Team. All team members are covered under a

Workman’s Compensation Policy following Board approval.

As the Team is a part of the Washington County DEM, a background check, a criminal history check and driving history check will be conducted.

All applicants are required to submit 2 typed letters of recommendation from an employer, pastor, teacher, etc. Each applicant must sit for an interview with their

potential training coordinator or a Board member. Upon request, or at the interview, applicants will be provided a copy of the SAR Bylaws to review.

Please contact the Team President or Secretary regarding questions or concerns regarding any part of the application or membership process.

Following processing, applications are presented and voted upon at each monthly SAR Board of Directors meeting.

I have read and understand the above requirements. I state that all information provided on the application is correct.

Signature ____________________________________________________________________________

Do Not Write Below This Line

Name of Team Member Receiving Application_______________________________ Date Received_______________________________

Date Received by Team Secretary __________________ Method received____________________________________________

Date Criminal History Check Request __________________ Criminal History Check Completed ________________

Date Reference Check Complete __________________ By________________________________________________________

Date of Interview __________________ By_______________________________________________________

Date of Board Review __________________ Approved ______________ Disapproved _____________________

Date of New Member Notification __________________ By_______________________________________________________

Date of Workman’s Comp Notification __________________

Date of Probationary Period Review __________________ By_______________________________________________________

Approved ______________ Disapproved ______________________

Team Member Number _____________ Unit ______________ Guardian Angel______________________________________________

Investigator’s Remarks:

____________________________________________________________________________________

____________________________

Investigator’s Signature

Rev. 8/06