Apply for Volunteer Emergency Responder - Dodge County Emergency Response Team Inc

Middle Initial

Date of Birth

Are you a US Citizen?

Yes

Do you reside within Dodge County?

Yes

Have you ever worked for Dodge County Emergency Response Team Inc.?

Yes

Have you ever been convicted of a felony, misdemeanor or criminal traffic violation?

Yes

Have you ever been charged with a violent crime, domestic abuse, or a sex crime?

Yes

Have you ever been convicted of an OWI (Operating While Intoxicated) or DUI (Driving Under the Influence)?

Yes

Do you have any felony, misdemeanor or criminal traffic charges pending against you?

Yes

Have you been convicted of more than 2 traffic violations in the past 5 years?

Yes

Do you have physical or mental limitations that would prohibit you from fulfilling the duties of the position you are applying for? If yes, please explain below in the 'Other Pertinent Information' section.

Yes

Do you have an unrestricted and unconditional WI Class D Driver's License?

Dodge County Emergency Response Team Inc. provides equal membership opportunities to all persons. All applicants will receive consideration for membership without regard to race, creed, religion, physical appearance, gender, color, sex, sexual orientation, gender identity/expression, national origin/ancestry, age, disability, marital status, political affiliation, disabled veteran status or other protected status. By clicking below I acknowledge this statement.

I hereby affirm that the information provided on this application (including any uploaded documents) is true and complete. I understand that any false or misleading representation or omissions may disqualify me from further consideration for membership and may result in discharge from membership if discovered at a later date. I understand that completion of this application does not assure me of a position with Dodge County Emergency Response Team Inc. By clicking below I acknowledge this statement.

I understand that this is an unpaid volunteer position, and that if selected, I will not be compensated.

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Volunteer Emergency Responder

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