Water Unit Application
Matzil Search and Rescue
Name
*
Legal First Name
Legal Last Name
Preferred Name
First Name
Email
*
example@example.com
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternative Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
/
Month
/
Day
Year
Date
Marital Status
*
Single
Engaged
Married
Separated
Divorced
Widowed
Have you ever been convicted of a felony?
*
Yes
No
Please Upload A Profile Picture of yourself.
*
Browse Files
Drag and drop files here
Choose a file
Should be a recent image of yourself. No Selfies, No Caps or Hats.
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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
*
None
Basic First Aid
Wilderness First Aid
CFR
EMT-B
EMT-P
RN
NP or PA
MD or DO
Other
Active FEMA Certifications
*
None
FEMA ICS-100
FEMA ICS-200
FEMA ICS-300
FEMA ICS-400
FEMA IS-700
Other
Other Certifications
Lifeguard
DHSES SWFT
Swiftwater Rescue Operations
Swiftwater Rescue Technician
Advanced Swiftwater Rescue Technician
Swiftwater Body Recovery Specialist
Swiftwater Incident Commander
Rescue Swimmer
Water Rescue Boat Operations
Boating Safety Certificate
Open Water Diver
Advanced Open Water Diver
Rescue Diver
Divemaster
Master Scuba Diver
Instructor (BLS, ACLS, EMT, or Lifeguard)
Law Enforcement Officer
Firefighter
C.E.R.T.
CEVO
EVOC
Mental Health Prof.
CPR/BLS
ACLS
Other
Other Expertise
Seasoned Outdoorsman
Mountaineering
Backpacking
Wilderness Survival
Topography/Nav.
Man-Tracking
Canine (SAR)
Water Rescue
Diving
Dispatching
Military Experience
Information Technology (IT)
Public Relations
Legal
Accounting
Other
Access to Equipment
Helicopter/Airplane
Drone
Water Rescue Equipment
Dive Equipment
Motorized Boat
Non-Motorized Boat
Other
What do you do for work?
Do you have any medical conditions or are you taking any medications on a regular basis?
*
Yes
No
Describe your level of physical fitness, swimming and diving capabilities and experiences to the best of your abilities?
*
Reference 1 Name
*
First Name
Last Name
Reference 1 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How long has this reference known you?
*
What is your relationship to this reference?
*
Reference 2 Name
*
First Name
Last Name
Reference 2 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How long has this reference known you?
*
What is your relationship to this reference?
*
Reference 3 Name
*
First Name
Last Name
Reference 3 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How long has this reference known you?
*
What is your relationship to this reference?
*
How did you find out about Matzil?
*
Date Submitted
*
-
Month
-
Day
Year
Date
I hereby certify that everything listed above is honest and truthful to the best of my knowledge
*
Your Name
Submit
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