Greenville County Special Operations Team Application

Greenville County Special Operations Team Application
Full Name:

First NameLast Name
Membership Status
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail:
example@example.com
Drivers License Number:
Last 4 of SSN:
Cell Phone Number:
Cell Phone Provider:
Cell Phone Type
Emergency Contact 1:

First NameLast Name
Emergency Contact 1 Phone Number:
Emergency Contact 2:

First NameLast Name
Emergency Contact 2 Phone Number:
If you have an Active911 Code enter it here:
Training Certifications

(Check all that apply)
ICS Certifications
Hazardous Materials Certifications
Technical Rescue Certifications
Fire Certifications
Aircraft Rescue Certifications
Emergency Medical Certifications
Additional Certifications not mentioned above, if applicable:
By submitting this signed application, I understand that I must attend at least 50 percent of trainings offered to continue being a part of the team.
Select the discipline(s) you are applying to be apart of:
Signature
Department Information

Please complete all the information below. Upon form submission, an approval request email will be sent to the email address of the department head provided.
Department Head:

First NameLast Name
Department Head Email Address
example@example.com
Department/Organization:
Job Title:
Department Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Other Memberships:
Mutual Aid Agreement Signed
Should be Empty:

Training Certifications