Applicants must be at least 19 years of age, in good health and physical condition,
and have been a resident of Washakie County for at least 1 year

Date of application: (00/00/00)

Proposed by:

Last Name:  

Home Phone:

D.O.B. (00/00/00)

Zip code:

Work Phone:

Cell Phone:

First Date of Residency: (00/00/00)

Weight:

Eye color:

Drivers License #:
(000000-000)

Social Sec #:
(000-00-0000)

Employer:

How Long (years):

Email Address:

Are you available for 24 hour call-outs?  

  Choose One: Yes No

Have you ever been convicted of a crime?

  Choose One: No Yes

If yes, please explain:

Explain why you want to join:

Do you have Search and Rescue experience?

  Choose One: No Yes

If yes, please explain:

What equipment do you have to assist with Search & Rescue operations?

Emergency Contact:

Phone #:

I hereby certify that the above statements are true. Any falsification is fully sufficient cause for refusal or denial of application.
NOTE: Applicants must be at least 19 years of age, in good health and physical condition, and have been a resident of the
county for at least 1 year.

  Choose One: No Yes