Greenville County Special Operations Team Application

Greenville County Special Operations Team Application
Full Name:*

First NameLast Name
Membership Status*

New Team MemberUpdate Member
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*

AndriodApple
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

ICS 100ICS 200ICS 300ICS 400ICS 700ICS 800
Hazardous Materials Certifications

Hazmat AwarenessHazmat OperationsHazmat TechnicianHazmat SpecialistChlorine Response SpecialistRisk Based Response Air Monitoring
Technical Rescue Certifications

3310 Tech Rescuer/Rope Ops3316 Rope Rescue High Angle Ops3350 and/or Equivalent Water Rescue Operations3390 Confined Space Entry Operations3312 Trench Rescue 13392 Confined Space RescueCollapse Shoring CertificationOpen Water Dive CertificationPublic Safety Dive 1Public Safety Dive 2
Fire Certifications

1210 EVDT1211 Class E1220 Pump Ops1250 Aerial Ops1153 Firefighter 11154 Firefighter 21181 Wildland Fire Training2150 Incident Safety OfficerFire Officer 1Fire Officer 2Fire Officer 3Fire Officer 4
Aircraft Rescue Certifications

3400 Airport Firefighter3402 Municipal FD Approach to Aircraft Rescue3409 ARFF Foam and Flammable Liquids Firefighting
Emergency Medical Certifications

1800 Emergency Medical Responder1820 EMT BasicParamedicTox Medic
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:*

Collapse, Trench and ShoringConfined Space/ Rope RescueDive RescueHazMatSearch & RescueSwiftwater Rescue
Signature*

Clear
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:

SCTF1SCTF6H.A.R.T
Mutual Aid Agreement Signed

YesNo
Should be Empty:

Greenville County Special Operations Team Application

Training Certifications

Department Information