All questions MUST be answered and the applicant MUST be the person completing this form. This information will be used as a basis for a detailed investigation of your background and must be honestly and accurately reported. Failing to disclose information will result in an automatic application rejection. NOTE: If you need additional space please use Section 7: Supplemental Information.

IMPORTANT: If volunteer is under 18 years of age a parent's or guardian's signature must also be provided

If you answer "Yes" to any of the following questions, please provide a full explanation in Section 7: Supplemental Information. Explanations MUST include dates. Please Note: Answering "Yes" will not necessarily preclude you from becoming a volunteer with Spokane County; however, failing to disclose information will automatically result in an application rejection.

This section is to be used to write more information and/or a detailed explanation for any of your responses on this form. Please include the section number for all information and explanations added.

Please review the items that are part of this WAC and sign and date to approve you have read the information. This information is also available online.

(1) Emergency workers shall be responsible to certify to the authorized officials registering them and using their services that they are aware of and will comply with all applicable responsibilities and requirements set forth in these rules. (a) Emergency workers have the responsibility to notify the on-scene authorized official if they have been using any medical prescription or other drug that has the potential to render them impaired, unfit, or unable to carry out their emergency assignment. (b) Participation by emergency workers in any mission, training event, or other authorized activity while under the influence of or while using narcotics or any illegal controlled substance is prohibited. (c) Participation by emergency workers in any mission, training event, or other authorized activity while under the influence of alcohol is prohibited. (d) Emergency workers participating in any mission, training event, or other authorized activity shall possess a valid operator's license if they are assigned to operate vehicles, vessels, or aircraft during the mission unless specifically directed otherwise by an authorized official in accordance with RCW 38.52.180. All emergency workers driving vehicles to or from a mission must possess a valid driver's license and required insurance. (e) Use of private vehicles, vessels, boats, or aircraft by emergency workers in any mission, training event, or other authorized activity without liability insurance required by chapter 46.29 RCW is prohibited unless specifically directed otherwise by an authorized official in accordance with RCW 38.52.180. (f) Emergency workers shall adhere to all applicable traffic regulations during any mission, training event, or other authorized activity. This provision does not apply to individuals who have completed the emergency vehicle operator course or the emergency vehicle accident prevention course and who are duly authorized under state law to use special driving skills and equipment and who do so at the direction of an authorized official.

(2) Emergency workers have the responsibility to comply with all other requirements as determined by the authorized official using their services.

(3) When reporting to the scene, emergency workers have the responsibility to inform the on-scene authorized official whether they are mentally and physically fit for their assigned duties. Emergency workers reporting as not fit for currently assigned duties may request a less demanding assignment that is appropriate to their current capabilities.

(4) Emergency workers have the responsibility to check in with the appropriate on-scene official and to complete all required recordkeeping and reporting.

[Statutory Authority: Chapter 38.52 RCW. 01-02-053, § 118-04-200, filed 12/28/00, effective 1/28/01; 93-23-005 (Order 93-08), § 118-04-200, filed 11/4/93, effective 12/5/93.]

Listed below are the state’s and county’s guidelines for POV utilization. After reviewing these guidelines, you will be required to sign a vehicle agreement.

~If a volunteer is responding under a state mission number, which includes all SAR callouts, state requirements are applicable and volunteers will be covered by the State's insurance while traveling and responding. Units must submit timely training schedules so that state mission numbers may be obtained for all trainings so volunteers fall under the state guidelines. This also reduces insurance costs to Spokane County.

~If volunteers are not covered under a state mission number and their personal insurance is below the county standard, and/or they are not current with the defensive driving training, they will not be authorized to use their POV past arriving at the ICP (Incident Command Post). It is the volunteer's responsibility to follow these guidelines.

~Washington State's insurance requirements for POV use are as follows: Volunteers must possess a valid driver’s license and insurance at $25,000/$50,000 bodily injury and $10,000 liability per WAC 46.29.490. This is the legal requirement for all drivers in Washington State.

~Transport to and from the ICP: the state standard applies and no additional coverage is provided by the county. POV use past the ICP: the Spokane County Vehicle Use Policy requires coverage at $100,000/300,000 liability and $50,000 property damage or $300,000 combined single limit and authorization from the IC (Incident Commander). The County does not require liability insurance from volunteers for privately owned Off-Road vehicles such as 4-wheelers, snow mobiles, horses, etc. when used in conjunction of their volunteer duties.

~The County advises each POV operator to review your personal auto insurance policy to ensure coverage is afforded when utilizing their vehicle for “incidental use for business” as insurance policy coverage and exclusion language differs from company to company. Personal auto insurance follows the vehicle and is the Primary Insurance up to the policy limits. Any County insurance coverage is secondary and provides coverage above the required POV primary coverage limits.

~In addition, all operators of County or POV vehicles used for County business or purposes are required to complete the following:

1. Driver Improvement Training every 3 years. Driver improvement can be: Defensive Driving course or EVOC/EVAP.

2. Vehicle Use Acknowledgement Form. Each authorized vehicle operator (County or POV) is required to sign the form acknowledging that they have read and understand the Vehicle Use Policy and the Accident Reporting Policy.

Please review the county policies through the links below BEFORE you sign the agreement:

In consideration for authorization of use of a Spokane County vehicle, or use of my privately owned vehicle for County business or purpose, I acknowledge that:

1. I have read, understand and shall comply with the content of Spokane County Policy #630 (Vehicle Use).

2. I have read, understand and shall comply with the content of Spokane County Accident Prevention Policy # 1.7 (Accident Reporting).

3. I acknowledge that having the authorization for use of a vehicle for County business/ purposes can be suspended or revoked at my Department Head’s discretion.

I understand that I will be an emergency response volunteer supporting Greater Spokane Emergency Management (GSEM) and its partners: City and County law enforcement, City and County fire services, 911, etc. and will never represent myself as anything other than being a volunteer in support of these organizations.

I understand that maintaining confidentiality of information while responding to an incident is a requirement of being a volunteer with GSEM. I may have access to sensitive information, such as investigative information, and I understand that all information seen or heard by me is strictly confidential. I understand that volunteers must NEVER release any information to other persons, whether copied, printed, or spoken verbally. All information on-scene stays at the scene.

I understand that release of confidential information could violate the law and could result in civil and/or criminal penalties as provided by the law.

While being an emergency response volunteer for GSEM, I will uphold a positive image for all the organizations with whom I engage and will take full responsibility for my actions. While on scene, I will listen and follow the instructions of the Incident Commander (IC) and/or Public Information Officer (PIO). I will remember that I am a support person at the scene and will not interfere with the work of on-scene first responders.

I will strive to be professional and friendly in all my interactions, and will abide by the GSEM team values. I also will strive to be respectful of my fellow volunteers/teammates.

If any portion of this agreement is violated, I may be immediately removed from participating as a volunteer with GSEM. I understand that my role as a volunteer with GSEM may be terminated at any time, and for whatever reason, pending an appeal with the Emergency Management Operations Group.