 Application Form
Application for Membership |
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Name: Last ____________First ____________ MI _____ Address: Apt: ____________________________ City: _____________State: Zip: _______________ Date of Birth: / / Phone: - M D Y Soc. Security #: - - . Ht: Wt: Hair: Eyes: Glasses: . Scars: . Any Health Problems: (please specify if you’re on medication) ________________________________________________________________________ _______________________________________________________________________ ___________________________________ ________________________________________________________________________ ___________________________________ Have you ever been arrested? (If yes, for what?) __________________________________________________________________________ _________________________________________________________________________ ____________________________________ __________________________________________________________________________ _____________________________________ Father: ________________________________ First MI Last Mother: __________________________________ First MI Last Grade: ____________ Counselor: _____________________ Drivers License No.(if applicable): _______________________________ Employers Name: _______________________________ Employers Address: _____________________Phone:_________ Position: ___________________Avg. Hrs Per Week:___________
Give three references not related to you (At least one should be a teacher) 1)Name:_________________________________________________________ Address:_________________________________________________________ Phone:__________________________________________________________ 2)Name:_________________________________________________________ Address:_________________________________________________________ Phone:__________________________________________________________ 3)Name:_________________________________________________________ Address:_________________________________________________________ Phone:___________________________________________________________ List any hobbies, organizations, or teams you belong to: __________________________________________________________________ _____________________________ __________________________________________________________________ _____________________________ __________________________________________________________________ _____________________________
Why do you want to join the Lake Suburban Explorer Post #911?
__________________________________________________ ________________________________________________________________________________________ ___________________________________________________ ________________________________________________________________________________________ ___________________________________________________ ________________________________________________________________________________________ _____________________________________________________ ***************************************************************************************** By signing this application, I agree to let a representative of the Lake Suburban Post #911 contact any of the above listed persons for the purpose of a background investigation, and I concede that the above information is accurate and true to the best of my knowledge.
Applicants Signature: Date:
Parents Signature: Date:
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