Matzil Water Unit Application

Water Unit Application

Matzil Search and Rescue
Name*

Legal First NameLegal Last Name
Preferred Name
First Name
Email*
example@example.com
Cell Phone*
Please enter a valid phone number.
Alternative Phone Number
Please enter a valid phone number.
Primary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Marital Status*

SingleEngagedMarriedSeparatedDivorcedWidowed
Have you ever been convicted of a felony?*

YesNo
Please Upload A Profile Picture of yourself.*

Should be a recent image of yourself. No Selfies, No Caps or Hats.
Cancelof
Are you currently or were you ever affiliated with any organizations?*
If yes, please list organizations and years affiliated (eg. Matzil: 2020-Current)
What Shul or Shuls are you affiliated with?
Please type what Shul or Shuls you consider yourself a member of
Active Medical Certifications*

NoneBasic First AidWilderness First AidCFREMT-BEMT-PRNNP or PAMD or DOOther
Active FEMA Certifications*

NoneFEMA ICS-100FEMA ICS-200FEMA ICS-300FEMA ICS-400FEMA IS-700Other
Other Certifications

LifeguardDHSES SWFTSwiftwater Rescue OperationsSwiftwater Rescue TechnicianAdvanced Swiftwater Rescue TechnicianSwiftwater Body Recovery SpecialistSwiftwater Incident CommanderRescue SwimmerWater Rescue Boat OperationsBoating Safety CertificateOpen Water DiverAdvanced Open Water DiverRescue DiverDivemasterMaster Scuba DiverInstructor (BLS, ACLS, EMT, or Lifeguard)Law Enforcement OfficerFirefighterC.E.R.T.CEVOEVOCMental Health Prof.CPR/BLSACLSOther
Other Expertise

Seasoned OutdoorsmanMountaineeringBackpackingWilderness SurvivalTopography/Nav.Man-TrackingCanine (SAR)Water RescueDivingDispatchingMilitary ExperienceInformation Technology (IT)Public RelationsLegalAccountingOther
Access to Equipment

Helicopter/AirplaneDroneWater Rescue EquipmentDive EquipmentMotorized BoatNon-Motorized BoatOther
What do you do for work?
Do you have any medical conditions or are you taking any medications on a regular basis?*

YesNo
Describe your level of physical fitness, swimming and diving capabilities and experiences to the best of your abilities?*
Reference 1 Name*

First NameLast Name
Reference 1 Phone Number*
Please enter a valid phone number.
How long has this reference known you?*
What is your relationship to this reference?*
Reference 2 Name*

First NameLast Name
Reference 2 Phone Number*
Please enter a valid phone number.
How long has this reference known you?*
What is your relationship to this reference?*
Reference 3 Name*

First NameLast Name
Reference 3 Phone Number*
Please enter a valid phone number.
How long has this reference known you?*
What is your relationship to this reference?*
How did you find out about Matzil?*
Date Submitted*

MonthDayYear
Date
I hereby certify that everything listed above is honest and truthful to the best of my knowledge*
Your Name
Should be Empty: