ACRU Application

Alamance County Rescue Unit Membership Application
Personal Information
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Age
Date of Birth

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Drivers License #
Social Security Number
High School
Graduated?

YesNo
College
Graduated?

YesNo
Major/Degree
Skills and Experience
Do You Hold a Valid EMS Credential?

NoEMREMT-BAEMTParamedic
Expiration

MonthDayYear
Date
Please list any relevant certifications / training /education you have obtained
Previous Emergency Volunteer Experience - Explain:
Basic Requirements
Have you ever abused alcohol and/or drugs?*
Please explain the circumstances
Do you understand that in order to be available for emergency call-outs, you must be able to arrive at base (or on scene) promptly and have abstained from alcohol and drugs for the previous 8 hours?*
I agree to provide, as an attachment, a legal background check and driving record. (If you have lived in another county in the past 5 years we will need a background check from that county as well)*
Upload background check

Browse Files

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I affirm that I have no physical or mental disabilities that would prohibit me from safely performing the duties and job tasks of Alamance County Rescue Unit*
References
Personal References (3)
Employment History (last 3)
Terms and Conditions
I have been a resident of Alamance County or an adjacent county for at least one (1) year. I agree to a six (6) month probationary period while being considered for membership with Alamance County Rescue Unit, and understand that I may be required to have a physical examination and/or statement of health from a physician. I agree to follow the rules and regulations existing or later adopted by the membership governing the organization.

I understand that I will occupy a position of public trust and that I will be called upon to make judgments, which may have a critical impact on the lives of the citizens I serve. If accepted for membership, I agree to resign upon demand by the Chief of the organization if any of the following occur, which would affect the effective performance of my duties:
1. reporting to duty with the odor of alcohol on my breath; noticeable impairment of mental or physical faculties due to drug or mental impairment, whether prescribed or recreational
2. deterioration of health
3. failure to report for the minimum amount of volunteer service
4. for conduct which would cause my reputation and/or the reputation of this organization to be questioned.
I understand and accept that the majority of the membership of this organization may at any time vote to terminate my membership upon sufficient showing of factors which would prevent me from continuing in effective service.

I pledge that the answers previously given are true, of my own knowledge, and all questions have been answered honestly and voluntarily. I understand that any false statement will be reason for rejection of my application or reason for the termination of one's membership. I understand that Alamance County Rescue Unit, Inc, is on call for any rescue emergency twenty-four (24) hours a day, seven (7) days a week.
Date

MonthDayYear
Date
Signature*
Parent/Guardian Signature

Clear
Should be Empty:

Alamance County Rescue Unit Membership Application

Personal Information

Skills and Experience

Basic Requirements

References

Terms and Conditions