LETTER OF INTEREST

Please fill in this form and press "submit" if you are interested in joining the Team.
Diver candidate: Support Candidate:
Name:    
Address:
Address2:
City, State, Zip    
Home Telephone
Work Telephone
Mobile Telephone
E-Mail
Social Security Number
Date of Birth "MM/DD/YYYY"
Drivers License #
Drivers License State
Spouse's Name
Emergency Contact
Emergency Contact #
Current Employer
Ocupation
EXPERIENCE
Mark all that apply
Name Certified Agency Expiration
CPR
CPR Trainer  
Lifeguard  
Para-Medic
First Aid
Name Active Department
Public Safety Officer
Fire Professional
 CORE DIVING CERTIFICATIONS
Please complete the following fields if you are a Diving Candidate only.
CERTIFICATION LEVEL AGENCY STUDENT # YEAR OBTAINED
SPECIALTY CERTIFICATIONS
CERTIFICATION LEVEL AGENCY STUDENT # YEAR OBTAINED
PERSONAL DIVING EXPERIENCES
Describe your best dive:
  Purpose of this dive:
 
LOCATION CURRENT GAS USED VISIBILITY MAX DEPTH
 
Describe your worst dive:
  Purpose of this dive: 
LOCATION CURRENT GAS USED VISIBILITY MAX DEPTH
 
Describe your most technically challenging dive:
  Purpose of this dive: 
LOCATION CURRENT GAS USED VISIBILITY MAX DEPTH
REFERENCES
Please let us know of a few people who can discuss your diving and personal values with us.
Name:  Telephone: 
Name:  Telephone: 
GENERAL QUESTIONS
How will the Dive Team benefit from your membership?
What tasks of diving make you most uncomfortable?
Any prior experience working with Public Safety agencies?
This is not a dive club. When a call for assistance comes out, each person is depended upon to respond when not at work. Are you willing to be on-call 24 hours a day 7 days a week, except hours at work?
Answer?
Comments:
When you select the "Submit" button below, your "Letter of Interest" will be sent to the Diving Control Board" for review and follow-up.  You should expect to have a response, either via e-mail, telephone, or post within a week.  If not, please re-submit this form.

Thank you!
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