APPLICATION FOR RESCUE VOLUNTEER

Name: MOHAMMAD KAZIM Father Name: MUHAMMAD HASSAN

Address: 81-E BLOCK, MODEL TOWN
City/Postcode: LAHORE/54000
Phone: 042-35915081 Mobile: 0321-4971107
National Identity Card #: 35202-7394393-5
Email: Date of Birth: 03/07/1987
kazimsaati@hotmail.com
Qualification: BACHELORS OF BUSINESS ADMINISTRATION
(HONOURS)
Person to be contacted in case of emergency:

Name: HASSAN RAZA Relationship: UNCLE

Address: 81-E BLOCK, MODEL TOWN, LAHORE
Phone: 042-35915018 Mobile: 0321-8441160
Profession:

Govt. Servant Self Employed Business

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

It has always been my passion to become a rescuer and it is the need of the
hour as well.

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

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

I can help my immediate family as well as my neighbors in case of an

emergency once I become a trained rescuer.

How much time can you contribute to Rescue 1122?

Daily-Hours 3-4 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?
Yes, subject to availability of time and resources.

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: Nawazish Ali Relationship: Grand father

Address: 81-E BLOCK MODEL TOWN, LAHORE
Phone: 042-35915138 Mobile: N.A
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: ______________________________________________

0321-7015231