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Volunteer Application

Thanks for your interest in Commerce Emergency Corps (CEC) and your heart to serve the community. Our organization provides EMS and fire rehab services to Hunt County residents.

The information you provide will be used to perform a background check. Your application is considered confidential and only shared with authorized CEC personnel. We evaluate applications based on merit, suitability for the role, and experience. We are an Equal Opportunity organization.

If you have questions about CEC or this application, email CommerceECorps@gmail.com

Personal Information
Full LEGAL Name (First, Middle, Last):

Date of Birth:

Gender:
---MaleFemaleOther

Street Address, City, Zip:

Phone:

Email:

Preferred method of contact:
---No preferencePhoneTextEmail

Background Check Information
Driver's License #:

State:
---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Last 4 digits of Social Security #:

Maiden Name and/or other names you have used:

States you have lived in after age 17 (excluding Texas):

Have you ever been charged or convicted of a criminal offense? Do not include traffic violations.
---YesNo
If yes, provide details below:

Skills and Interests
Do you hold any of the following certifications? Use ctrl+click to check all that apply.
BLS CPRACLSEMAEMREMT-BEMT-AEMT-P

Why do you want to volunteer with us? What motivated you to get in touch with us?

Tell us any skills or interests you have that may benefit the department.

References
Name:

Phone or Email:

Name:

Phone or Email:

Name:

Phone or Email:

Referred By
How did you find out about us?
---Social Media/InternetWord of MouthCurrent/Past Member (please provide name)Other (please provide details)
Member Name/Other:

Emergency Contact
Name:

Phone:

Authorizations/Acknowledgements
I authorize Commerce Emergency Corps to obtain personal information which includes charges and/or convictions of federal and state law violations. Personal information may also be obtained from public sources such as social media. This information will be used to determine eligibility for a volunteer position with the organization. This authorization remains in effect until the volunteer position ends. I may request a copy of information obtained.

If offered a position with the organization, I understand final approval is contingent on successfully passing a drug test.

I declare the information I have provided is true. I acknowledge and understand providing false information may result in dismissal from the organization.

Signature:

Date: