McDowell County Rescue and Ambulance Squad

McDowell Rescue Volunteer Application

Type of Applicant
Probationary (18 years of age or older)
Junior (16-17 years of age)
Cadet (14-15 years of age)
Auxiliary
 
Name (required)
 
 
 
Physical Address (required)
 
 
Have you lived anywhere else in the past 10 years?
Yes
No
 
Is your mailing address different from your physical address?
Yes
No
 
 
 
Do you have a valid drivers license?
Yes
No
 
Do you know any current MCRS employees/​volunteers?
Yes
No
 
 
Have you ever received a moving traffic violation?
Yes
No
 
Have you ever been convicted of a criminal offence? (Not including infractions)
Yes
No
 

Education

School 1

 
Type of School
High School
College
Bus. or Trade School
Professional School
 
Location of School
 
 
 
 
Have you ever served with any other emergency services organization?
Yes
No
 
Do you currently hold a North Carolina OEMS or NREMT certification?
Yes
No
 
Do you hold any NCOSFM Technical Rescuer certifications ?
 
 
Do you or have you served any any branch of the United States Armed Forces?
Yes
No
 
Do you currently work?
 

Health

 
 
Do you have any of the following chronic health conditions? (Select all that apply)
COPD
Asthma
Heart Failure
Diabetes
Hypertension
Atrial Fibrillation
Angina
Other (Please Specify)
 
 
 
Have you had a physical within the past two years?
 
 
 

References

Please list at least one reference that you have known for at least two years that is not related to you and is not a former employer.

Reference 1

Name
 
 
 
 
 
 
 
or drag files here.
     

    Please upload your resume in PDF or Word format.

     
     

    By electronically signing this document, you agree that all information is accurate and that MCRS membership personnel may contact you regarding this application

     

     

    We're ready...When you need us most

    Physical Location: 186 State Street, Marion NC 28752
    Mailing Address: PO Box 883, Marion NC 28752

    PHONE: (828) 652 6033
    FAX: (828) 659 3029

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