Dear Future Thurston County Emergency Management Volunteer:

Thank you for your interest in becoming a volunteer with Thurston County Emergency Management. Recognizing our high responsibility to our community and the unique qualifications for our volunteers, we require that all who wish to volunteer with emergency management undergo a complete eligibility screening. The information in this form is used to complete the process.

Volunteer Information

Please check the box below to indicate which volunteer group you are applying for: *

	Thurston County Disaster Assistance Response Team (TCDART)	Thurston County Equine Outreach (TCEO)
you must have at least one item	Thurston County Disaster Assistance Response Team (TCDART)	Thurston County Equine Outreach (TCEO)

First Name *

Last Name *

MI

Suffix

Other names by which you have been known (for example: maiden name)

Date of Birth * +

Gender *

Race/Ethnicity *

Height (in inches) *

Weight (in lbs) *

Hair Color *

Eye Color *

WA Driver's License Number *

Expiration Date * +

Street Address *

City *

State *

Zip *

Years at this address *

Phone *

Email *

Confirm Email *

Highest Education Completed *

Have you ever been convicted of a felony, gross misdemeanor, or misdemeanor, other than a minor traffic offense? *

Yes

No

If yes, please explain:

Do you have any physical problems which would preclude you from performing any phase of volunteer work? *

Yes

No

If yes, please explain:

References

Please provide 3 personal references

Reference 1

Ref 1 Name *

Ref 1 Phone *

Ref 1 Email *

Ref 1 Relationship *

Ref 1 Years Known *

Reference 2

Ref 2 Name *

Ref 2 Phone *

Ref 2 Email *

Ref 2 Relationship *

Ref 2 Years Known *

Reference 3

Ref 3 Name *

Ref 3 Phone *

Ref 3 Email *

Ref 3 Relationship *

Ref 3 Years Known *

Release of Information

I swear or affirm that the information contained herein is the truth to the best of my knowledge and belief, and herewith give my consent for Thurston County Emergency Management to conduct a complete check of my criminal history for the purpose of ascertaining the accuracy of any of the information contained in this form.

Initial Here *

Emergency Contacts

Emergency Contact 1

EC 1 Name *

EC 1 Phone *

EC 1 Relationship *

Emergency Contact 2

EC 2 Name *

EC 2 Phone *

EC 2 Relationship *

Badge Photo

Photo Guidelines

Submit a color photo, taken in last 6 months.
Use a clear image of your face. Do not use filters commonly used on social media.
Have someone else take your photo.
Use a plain white or off-white background.

Upload Photo *

Release of Publication of Photograph and/or Video Recording

I certify that I am over 18 years of age and I hereby grant to Thurston County irrevocable and unrestricted right to edit, duplicate, exhibit, broadcast, copyright, use and publish photographs and/or video recordings of me, or in which I may be included, for any purpose and in any manner or medium. I hereby waive and release Thurston County, its officials, officers, agents, and employees from all rights, claims and liability I may have relating to said photographs and video recordings. I understand that I will not receive compensation from Thurston County for said photographs and video recordings.

Initial Here *

Volunteer Code of Conduct

Thurston County Emergency Management volunteers must meet and follow the Code of Conduct when representing Emergency Management during deployments, events, trainings, meetings, and any other activities where representation may be needed.

Volunteers shall:

Maintain and abide by the standards of their profession, including certification, and/or training requirements to support their Emergency Management role.
Put safety first in all activities and use all equipment appropriately and
Avoid profane and abusive language and disruptive behavior including behavior that is dangerous to self and others including, but not limited to: acts of violence, physical or sexual abuse, or harassment.
Always conduct themselves in a respectful nature by respecting the cultures, beliefs, opinions, and decisions of others and treating others with courtesy, tact, sensitivity, and humility.
Report all injuries, illnesses, and accidents that occur as a result of their Emergency Management participation to their unit leader.
Follow all Thurston County Policies and Personnel

Volunteers shall not:

Represent themselves as an Emergency Management volunteer at any given site without prior authorization/deployment from Thurston County Emergency Management.
Use Thurston County equipment or resources for personal
Comment, answer questions, or speak on behalf of the Thurston County Emergency Management to the media.
Publicly use any emergency management affiliation in connection with the promotion of partisan politics, religious matters, or positions on any issue.
Disclose or use any confidential Emergency Management information that is available solely as a result of the volunteer’s affiliation with Thurston County Emergency Management to any person not authorized to receive such information.
Respond for duty under the influence of prescription/non-prescription medication that may influence their ability to perform assigned functions.
Transport, store and/or consume alcohol, marijuana, and/or illegal substances while performing volunteer duties.

Signature

How would prefer to sign? *

I hereby acknowledge that I have read, understand, and agree to comply with all expectations and policies set forth in the Code of Conduct.

Signature *

clear

ELECTRONIC SIGNATURE AGREEMENT
The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.

Signature (type full legal name) *

Date * +