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ESU Application

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Contact Information








Legal Information

Are you over the age of 21 years?

Are you a us citizen or authorized to be in the United States?

Have you ever been convicted of a DUI, DWI or substance abuse?

Would you agree to submit to a drug test at any time during your membership if Requested?

Have you ever been convicted of violation of the law other than minor traffic offenses?




Military Service
Rescue Work

Do you have any prior experience in rescue work?

If yes, please fill out the following:


Were you...





List all special training courses that you have taken. If you are currently certified, write the expiration date beside the course.

Work History

List your past three employers beginning with the most recent.

Employer 1

Employer 2

Employer 3

Character References

Please list three personal character references other than relatives.

Reference 1

Reference 2

Reference 3

Availability

If accepted, approximately what hours would you be available? Please use am and pm with times.

If accepted, are there any unique circumstances we should be aware of to assist you in performing your duties?

If accepted, are there any special accommodations you would need to perform your duties?

Certify

I hereby acknowledge my complete understanding that the standby assignment I am volunteering for carries with it the requirement that I will, without question, obey and execute to the best of my ability the lawful orders of those designated to supervise and command my activities, that I will complete all assigned training courses, and that any violation or disregard of the rules and regulations of the Emergency Support Unit (ESU) will be cause for disciplinary action or dismissal. Furthermore, I understand that any false statements intentionally made in my application disqualifies me for membership in the Office of Emergency Management, Emergency Support Unit. I understand that in compliance with Tennessee State Law, all applications are subject to public disclosure, and according to T.C.A 47-10-107 (a)(d), Legal recognition of electronic records, electronic signatures, and electronic contracts, a record or signature may not be denied legal effect or enforceability solely because it is in electronic form, and if a law requires a signature, an electronic signature satisfies the law.

I have agreed to submit this application by electronic means. By signing this application electronically, I certify that:

  • I understand the questions and statements on this application;
  • My answers are correct and complete to the best of my knowledge;
  • I am the person applying for this position;
  • I authorize the Office of Emergency Management Director, or his designee, to verify the information I have provided in this application; and,
  • I authorize the Office of Emergency Management Director, or his designee, to conduct a records check of my traffic moving violations in Tennessee.




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