APPLICATION FOR MEMBERSHIP

U.S.WATER RESCUE DIVE TEAM

P.O. BOX 50626

BILLINGS, MT 59105

NAME:                                                                                                                                

ADDRESS:                                                                                          

PHONE: work)                                                home)                                                cell)______________________

E-mail:                                                                                                                                   

DOB:                                                                    

SSN:                                                                     

D/L:                                                                      

EMERGENCY CONTACT NAME:                                                                                 

EMERGENCY CONTACT PHONE:                                                                               

Current Employer Name:                                                                                                    

Current Employer Address:                                                                                               

Current Employer Phone:                                                                                                  

May we contact your employer?                                                                                     

Have you ever been convicted of or plead guilty or no contest to a misdemeanor? _____

Have you ever been convicted of or plead guilty or no contest to a felony?   _________

Have you ever been suspended, dismissed or asked to resign from any job? _________

If YES, explain in detail: __________________________________________________

Can you be released from your place of employment for Dive Team Operations if necessary?

Always                   Most Always _______          Occasionally ________        Never ________        

Do you understand that the membership you are applying for is a volunteer position and that you will not receive
financial or material compensation for services rendered? _______  

Do you understand that your signature on this application gives your consent and authorization to have a background
investigation conducted? _______