BCWR Application

Boone County Water Rescue Application

Please complete the form below to apply for a position with us. Note: Must live in Northern Kentucky area.
Full Name*

First NameLast Name
Current Address

Street Address

Street Address Line 2

CityState

Zip Code
Email Address*
Home Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Cell Phone Provider
Example: Verizon
Phone Type*
This information is used to assist with team app setup.
Height
Weight
SingleMarried
Spouse
Emergency contact if different than Spouse
Emergency contact phone number
Children, if yes please list names and ages
Name of High School
Year Graduated
High School
Name of College
Year Graduated
College
YesNo

I, the applicant named in the above (foregoing), do hereby certify that the information contained herein is true, correct and complete to the best of my knowledge. I am aware that, should an Investigation at any time disclose any misrepresentation or falsification, my application will be rejected, and my name will be removed from the team roster. I authorize the Boone County Water Rescue Team to make all necessary and appropriate investigations to verify the information contained herein. (for background check)
Social Security Number
Drivers Licenses Number
Include State. IE: Kentucky ABC-123-456
Date of Birth*

MonthDayYear
Signature*
Before the submit button will be available you must complete the electronic signature portion. If you are unable to sign the application electronically you may print the application, sign, and provide it in person or email it to applicant@boonecountywaterrescue.org
Should be Empty:

Boone County Water Rescue Application