LSUR New Member DIVER Application

Thank you for your interest in volunteering with Lee’s Summit Underwater Rescue & Recovery!

We welcome all qualified individuals with the ability to commit their time, energy and expertise to help us with our mission.

Important: This is a very demanding volunteer position. Our team holds required meetings once a month, training days six times per year, and quarterly equipment maintenance days. Due to the nature of emergency calls, every team member needs to be available 24/7/365 and notify the Director anytime they will not be available for an operation (e.g., vacations, etc.)

MINIMUM STANDARDS FOR ALL APPLICANTS

• Complete the online LSUR New Member Application (below)

• Meet with a LSUR Board Member for an interview (must bring copies of all certifications and Dive Logbook or copy of last 12 months)

• Be at least 21 years of age

• Have a valid Driver’s License

• Be a citizen of the United States

• Consent to a criminal background check. Applicant must not have any felony, alcohol or illicit drug related convictions within the last five years. ($25 Donation to LSUR to cover cost is appreciated.)

• Show a willingness to help LSUR accomplish its goals and objectives

• Allot sufficient time for training and responses

• Have reliable personal transportation

• Accept advice and directions willingly

• Have the ability to lift 50 pounds without assistance

• Be in a physically fit condition to perform duties without risk of injury to themselves or others

• Satisfactorily complete a surface swim test and survival float

ADDITIONAL REQUIREMENTS FOR RESCUE DIVER APPLICANTS

• Have a minimum of 10 hours of logged down time within the last two years

• Be certified as an Open Water Diver of a nationally certifying agency or an equivalent rating

• Have the ability to don and doff their SCUBA equipment, without assistance, in and out of the water

• Be able to successfully pass a Medical Examination and complete a Medical History form SF93 (will be issued to applicant at a later time)

• Satisfactorily complete a basic SCUBA skills evaluation.

Revised 10.8.2020

Date of Application

(mm/dd/yyyy)

Contact Information

Name

First Name

Last Name

Cell Phone

Verify Email

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Issuing State for Driver's License

Spouse Name (Optional)

Spouse Phone (Optional)

Experience (Please click all that apply)

CPR

CPR Trainer

Lifeguard

Lifeguard Trainer

Paramedic

First Aid

Public Safety

Other Experience or Non-Diving Certifications

Diving Certifications

Certification #1

Agency

Student # / Year Obtained

Certification #2

Agency

Student # / Year Obtained

Certification #3

Agency

Student # / Year Obtained

Diving Experience

Current (Please select one)

Slight

Moderate

Strong

Depth in Feet (Please click deepest level)

0 to 50

51 to 100

101 to 150

151 to 200

201 to 250

Greater than 251

Visibility (Please select lowest visibility experienced)

Zero

Less than 5 feet

10 feet

25 feet

50 feet

75 feet

100 feet +

Gas Experience (Please click all that apply)

Air

Nitrox 32%

Nitrox 36%

Trimix

Heliox

Purpose (Please click all that apply)

Military

SAR

Commercial

Recreational

Dive Location ( Please click all that apply)

Ocean

Bay

Pond

Quarry

River

Lake

Reference #1

Reference Number 1

Please provide name, address and phone number of your first reference.

Reference #2

Reference Number 2

Please provide name, address and phone number of your second reference.

Background Check

A background check is required after an interview with a teammber, before voted onto the team. The applicant is responsible for the fee at this time.