St. Louis County Rescue Squad Membership Application
Please fill out this form if you would like to apply for membership with the St. Louis County Rescue Squad. By submitting this form, you are agreeing to the following statement, "I understand that any omission, falsification, or misrepresentation of information will result in the termination of the application process and I shall not be voted on for membership."
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Full name (first, middle, last), any aliases, assumed names, or previous names. *
Date of Birth *
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Phone number *
Email Address *
Current Address *
Current City, State, Zip Code *
Addresses where you have lived previously in the past 5 years. *
Which division are you interested in? *
How did you hear about the St. Louis County Volunteer Rescue Squad? *
Why do you want to volunteer with the Rescue Squad? How long do you intend to volunteer? *
Once you are offered an opening as an active applicant, it’s important to attend Wednesday (Virginia division)/Thursday (Duluth division) meetings to take part in our training sessions. What is your availability/level of commitment to attend meetings for your selected division? *
The SLCRS responds to 400+ calls for service each year in addition to non-emergency standby events. Membership requires a delicate balance between your career, family life, and volunteering for the squad. What is your availability/level of commitment to respond to calls? (ie. Are you available on nights and weekends? Do you work overnight shifts and are free during the day?) *
Do you have any military, law enforcement, or EMS (fire department, ambulance service, etc) experience. If yes, what was your job and why did you leave? *
Have you ever been involved with any other volunteer organization? If yes, please name the organization. *
Have you ever been a party to any civil action or proceeding or have you ever been named in a notice of claim that you may be a defendant in a civil action or proceeding? If yes, give details. *
Have you ever been named as a defendant, or convicted in any adult proceeding (including speeding tickets but not parking tickets)? If yes, give details. *
List any contacts you have had with a law enforcement agency. List date, agency name, location and details for all contacts. *
List the names of any law enforcement officers or St. Louis County Rescue Squad Members you know. *
Do you have a valid driver’s license? *
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