Putnam Rescue - Application

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Putnam County Rescue Squad

Chief Stanley Vanhoosher Asst. Chief David Anderson

700 County Services Drive
Cookeville, TN 38501
931-528-1555

Application

First Name: MI: Last Name:
Address:
City: State: Zip:
Phone:
Email:

Birthdate: SSN: DL #:
Height Physical Condition: Blood Type:

Occupation: Employer:

Have you ever been convicted of a crime? Yes No
Do we have your permission to obtain a background check? Yes No
Are you willing to take a drug test? Yes No
Have you ever been a member of any emergency services before? Yes No
Check here if you would like to tell us additional information such as qualifications or certifications you currently hold.

I am fully aware that, if accepted, I will perform my duties to the best of my ability; that I will be in subjection to my superiors at all times; that the services I perform are strictly voluntary and that I will NOT receive pay or any other type of reimbursement for them; I also understand that any injury or bodily harm that I may receive that is not covered under the Putnam County Rescue Squad's insurance will be my personal responsibility.

I also understand that I will be on a probation period of one(1) year and during this period I will not be allowed to run emergency traffic in rescue squad vehicles or my own personal vehicle.

I will perform my duties in the Putnam County Rescue Squad to the best of my abilities, and if my conduct is unbecoming or I am not performing my duties, I will be dismissed and will return any and all equipment that belongs to the Putnam County Rescue Squad.

I certify that the above information is true and correct to the best of my knowledge.

By typing my name and submitting this form, I am agreeing to the above terms and conditions:

Name

Putnam County Rescue Squad Chief Stanley Vanhoosher Asst. Chief David Anderson 700 County Services Drive Cookeville, TN 38501 931-528-1555 Application

Putnam County Rescue Squad

Chief Stanley Vanhoosher Asst. Chief David Anderson

700 County Services Drive
Cookeville, TN 38501
931-528-1555

Application