APPLICATION FOR RESCUE VOLUNTEER

Name: Najam Nawaz Father Name: Muhammad

Saqib Nawaz
Address: House No 29 C ,C Block Near Deccan Garden
Samanabad Faisalabad
City/Postcode: Faisalabad
Phone: 0412664088 Mobile: 03013139526
National Identity Card
#:_____________________________________________
Email: Date of Birth: 02-10-1988
najam_nawaz@yahoo.com
Qualification: B.Sc. Electrical Engineering
Person to be contacted in case of emergency:

Name: Naeem Nawaz Relationship: Brother

Address: House No. 29 C, C Block Near Deccan Garden Samanabad
Faisalabad
Phone: 0412664088 Mobile: 03447746347
Profession:

Govt. Servant Self Employed Business

Working in Private Professional  Any Other
Organization
Why do you want to become a Rescue Volunteer?

In Pakistan we do not have enough resources to provide necessary facilities

to every individual so every citizen must take the responsibility to train
himself and further educate other people to have proper decision in case of
any emergency.

Do you already have any Emergency Training? (Please Describe)

NO

Any Experience of handling Emergencies?

NO

Do you have any relevant skills/experience useful for a Rescuer?

NO. However I have my mindset to develop a quick, secure and fruitful

response in case of any emergency.

How can you contribute as a Rescue Volunteer in your area?

 I can perform the duty like a professional rescuer after successfully
completing the training, if my services would be required. Moreover I can
educate other people to develop a professional response in an emergency.

How much time can you contribute to Rescue 1122?

Daily-Hours: 2 Hours Once a Week (Day & Hours)_____

×______________
Once a month (Date, Day, &
Hours)____________________×__________________________

Would you like to be trained as a Master Trainer to assist in

Community Training?

I shall decide after knowing the training period.

Do you have any Disability or Disease which can affect your

working?

(If yes, please

specify)________________________NO____________________________________

Please give details of two references:

1.Name:_____________________________ Relationship:_________________________
_ __
Address:_____________________________________________________________________
_
Phone:_______________________________ Mobile:______________________________
_ _
Relationship:_________________________
2.Name:_____________________________ __
_
Address:_____________________________________________________________________
_
Phone:_______________________________ Mobile:______________________________
_ _

I fully understand the risk involved in working as a Rescue Volunteer for

Punjab Emergency Service and still wish to offer my services on volunteer
basis.

Thumb Signature:__________________________
Impression:_____________________ ___
Date:________________________________
 _
(Final enrolment is subject to completion of training)

Photocopies of following documents to be attached:

1. C.N.I.C.

2. Domicile

3. Certificate of higher qualification

For office Use only: (To be filled by District Emergency Officer/Emergency

officer)

May be trained as

Rescue Volunteer Community Master Trainer

Emergency Trained reserve Citizen

Name of DEO/ EO: __________________________________________________

Signature of DEO/ SEO: ______________________________________________