APS Civil Defense Service
Uniformed Service Division Application
Name
*
First Name
Last Name
DoB
*
-
Month
-
Day
Year
Date
Gender? |Male/Female|
*
Please Select
Male
Female
Phone Number
*
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Education
*
Personal
*
Please Select
Yes
No
Citizen of the United States?
Currently employed?
*
Please Select
Yes
No
Employer/Company Name
Extracurricular activities/organizations
JROTC
ROTC
Civil Air Patrol
Young Marines
Scouts
Other extracurricular Activities
Skills
*
Mechanical experience
Mathematical knowledge
Technological experience
Scientific knowledge
Outdoor/Field experience
Leadership/Management skills
Firearms experience
Survival/outdoors experience
None
Military or Law Enforcement History
*
Please Select
Yes
No
Military Service?
Branch
Please Select
Army
Navy
Marine Corps
AirForces
Coast Guard
Status
Please Select
Active Duty
Reserves
National Guard
Military Service
Military Service (Type of Separation)
Retired
Discharged
Law Enforcement Service
*
Please Select
Yes
No
Status/ Department
Military Service (Type of Separation)
Retired
Discharged
Criminal History
*
Please Select
Yes
NO
If Yes. Criminal History
Which unit is closest to you
*
Please Select
210th San Antonio TX (Headquarters)
405th Stillwater OK
none
If there is not a unit nearby, Select one of the two "remote" options in the next question.
Membership desired in APS
*
Please Select
Active Staff
Reserve Staff
Remote status is limited (AD), (RD), (FL), (PA), and (IT) only!
What is your general availability? (Does not need to be exact.)
*
Free
Sometimes Free
Occupied
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Specialization Interested (choose three based on current skills and interests)
*
Civil Engineering (CE)
Electrical Mechanical Specialist (EM)
Cyber/Signals/Communications (CS)
Administrative Technician (AT)
Personnel Specialist (PS)
Finance Specialist (FS)
Morale Service Specialist (MO)
Chaplain (RP)
Legalman (LM)
Public Relations Specialist (PR)
Logistics/Supply (LS)
Security Forces (SF)
Information Security Technician (IT)
Medical Corpsman (MC)
Line Personnel (LN)
Messing Specialist (MS)
Forestry Patrolman (FP)
Field Specialist (FS)
OIA Joint Liaison (OL)
Undesignated (UD)
Statement
*
IN CONSIDERATION OF the risk of injury that exists while participating in AMERICAN PATRIOTS SOCIETY (hereinafter the "Activity"); and IN CONSIDERATION OF my desire to participate in said Activity and being given the right to participate in same; I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively, "Releasor," "I" or "me", which terms shall also include Releasor's parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity; and I HEREBY release and forever discharge AMERICAN PATRIOTS SOCIETY, located at 7622 Gentle Bend Dr, San Antonio, Texas 78250, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns (collectively "Releases"), from any physical or psychological injury that I may suffer as a direct result of my participation in the aforementioned Activity. I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK I AM AWARE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO: PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL TO AND FROM THE ACTIVITY, OR FROM CONDITIONS AT THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN AND UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY. I FURTHER AGREE to indemnify, defend and hold harmless the Releasees against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs. I FURTHER ACKNOWLEDGE that Releases are not responsible for errors, omissions, acts, or failures to act of any party or entity conducting a specific event or activity on behalf of Releases. In the event that I should require medical care or treatment, I authorize AMERICAN PATRIOTS SOCIETY to provide all emergency medical care deemed necessary, including but not limited to, first aid, CPR, the use of AEDs, emergency medical transport, and sharing of medical information with medical personnel. I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. I FURTHER ACKNOWLEDGE that this Activity may involve a test of a person's physical and mental limits and may carry with it the potential for death, serious injury, and property loss. I agree not to participate in the activity unless I am medically able and properly trained, and I agree to abide by the decision of the AMERICAN PATRIOTS SOCIETY official or agent, regarding my approval to participate in the Activity. I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE AMERICAN PATRIOTS SOCIETY AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST AMERICAN PATRIOTS SOCIETY FOR RIGHT THAT I OTHERWISE HAVE '10 HICLNG A LEGAL ACTION AGAINST AMERICAN PATRIOTS SOCIETY FOR PERSONAL INJURY OR PROPERTY DAMAGE. To the extent that statute or case law does not prohibit releases for ordinary negligence, this release is also for such negligence on the part of AMERICAN PATRIOTS SOCIETY, its agents, and employees. I agree that this Release shall be governed for all purposes by Texas law, without regard to any conflict of law principles. This Release supersedes any and all previous oral or written promises or other agreements. In the event that any damage to equipment or facilities occurs as a result of my or my family's or my agent's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions of neglect or recklessness. THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE DURATION OF MY PARTICIPATION IN THE ACTIVITY, DURING THIS INITIAL AND ALL SUBSEQUENT EVENTS OF PARTICIPATION. THIS AGREEMENT was entered into at arm's-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both Participant and AMERICAN PATRIOTS SOCIETY agree that this agreement is clear and unambiguous as to its terms, and that no other evidence shall be used or admitted to alter or explain the terms of this agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into. In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase, or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed, and enforced as so limited. I, THE UNDERSIGNED PARTICIPANT, AFFIRM THAT I AM OF THE AGE OF 18 YEARS OR OLDER, AND THAT I AM FREELY SIGNING THIS AGREEMENT. I CERTIFY THAT I HAVING READ THIS AGREEMENT, THAT I FULLY UNDERSTAND ITS CONTENT AND THAT THIS RELEASE CANNOT BE MODIFIED ORALLY. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND THAT I AM SIGNING IT OF MY OWN FREE WILL. PHOTO RELEASE For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby grant American Patriots Society permission to use my likeness in a photograph in any and all of its publications, including but not limited to all of American Patriots Society's printed and digital publications. I understand and agree that any photograph using my likeness will become property of American Patriots Society and will not be returned. I acknowledge that since my participation with American Patriots Society is voluntary, I will receive no financial compensation. I hereby irrevocably authorize American Patriots Society to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing American Patriot Society's programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge American Patriots Society from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I acknowledge that singing in the box below I agree to the terms and conditions listed above.
I consent to a background investigation.
*
Yes.
I agree to follow the rules and regulations as set by the APS Personnel Manual
*
Yes
Applicant Signature
*
Submit
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