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* 1. Name

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* 3. Phone

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* 4. Address

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* 5. Are you a North Carolina Licensed Vehicle Driver?

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* 6. Occupation and Employer

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* 7. List your qualifications that will be of service for the organization

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* 8. Reference Name

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* 9. Reference Contact Information

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* 10. Reference Name

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* 11. Reference Contact Information

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* 12. Have you been convicted of a felony

I herby grant Cherokee County Search and Rescue permission to investigate any and all information provided in this application.

I further understand falsifying any information on this application, is at the sole discretion of the membership grounds for immediate separation from CCSAR

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* 13. Signature

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