9CR AUXILIARY ID CARD APPLICATION ALL INFORMATION IS REQUIRED TO CREATE YOUR CARD Place curser in middle of each blank box and type in information: 1- NAME (First - Middle Initial - Last)

2- EMPLOYEE/ID (Member Number, 7 digits)

3- QUALIFICATIONS (IQ, BQ or AUXOP)

4- DATE OF BIRTH (Month /Day/Year)

5- WEIGHT (Pounds)

6- HEIGHT (Inches)

7- HAIR COLOR 8- EYE COLOR 9-BLOOD TYPE

FLOTILLA NUMBER ADDRESS: EMAIL: Note:

City

State

Zip

Phone

1. All information must be filled in. If blood type is not known, enter UNK. 2. A photo must be submitted with application. The .jpeg file must be identified by member name and Employee /ID#. 3. New Members who are in AP Status (Applicant Pending) must wait until their status is IQ or BQ before submitting this application and photo. 4. Members must have completed all mandatory training to receive a new card or have an old card renewed.

January 2016