Please indicate the scheduling preferences you have for each day of the week:

I understand that if accepted for membership in Lewis County Search and Rescue, Inc., I will complete the required training as soon as it is available. I also understand that the details of services performed by LCSR are to be held in confidence and I will not release any information unless directed by the manager or his/her designee. I further understand that any violation of the bylaws or standard operating guidelines, or failure to maintain training; unless exempted by the Board of Directors, may result in suspension or termination from LCSR.

Furthermore, I declare that I have received information pertaining to patient confidentiality. I understand that disclosure of confidential information without proper authorization is a violation of policy, patient’s rights, and federal and state regulations. Such violation will subject me to disciplinary action including possible termination of membership. I understand that violation of the New York State AIDS/HIV information confidentiality law may result in criminal penalties under Article 27-F of the New York State Public Health Law and PHL 800.15. I recognize that I must not disclose confidential information without proper authorization nor should I access confidential information without professional need to know. 

Furthermore, I do understand that Lewis County Search and Rescue reserves the ability to require the following testing and/or checks for  pre-employment, post-accident, and reasonable suspicion: fit for duty testing, reasonable suspicion testing, background checks, driving record check, and reference checks. I understand that my employment may be contingent upon successfully passing all required testing for the agency. 

Signing my name below acknowledges that I agree to all that has been stated above.

I have read the confidentiality statement and promise to comply with its provisions.