Untitled Document

USCG Auxiliary
Operation PATRIOT READINESS SAMPLE
Member Audit Form
created by:
http://www.cgaux1sr.org/mem/welcomeM.html

ljwestcgaux@mac.com

Name:			Member No.:
Address:
City:		State:	Zip Code:
Phone Numbers	Home:	Work:	Cell:	Fax:
	Others:		Others:
Email Addresses	Home:		Work:

Personal Training Qualifications

Qualification	Have	Want	Qualification				Have	Want
Coxswain			IT
Crew			TCT Facilitator
Pilot			LAMS IT
Air Crew			PATON Verifier
Observer			MEP First Responder
QE			Communication Watchstander
VE			Current Red Cross First Aid
CFVE			Current Red Cross CPR
TCT			ICS cert level:	100	200	300	400	Want

I have performed all currency maintenance for the above except:
I am willing to do CG or AUX Administrative Support missions: Yes No
I have these skill codes from the attached list: Click here for a complete list
I have had a security clearance within the last five years: Yes No
I have a current, laminated ID card, with photo: Yes No
I have the following additional CG qualifications/certifications:

Personal Availability

Anytime	Weekends	Weekdays	Evenings	Local Only	Will Travel
Yes No	Yes No	Yes No	Yes No	Yes No	Yes No

Surface Vessels Owned

Length	Location	Trailered	In water	Laid up	Offered for use	Under repair
		Yes No	Yes No	Yes No	Yes No *	Yes No
		Yes No	Yes No	Yes No	Yes No *	Yes No

Aircraft Owned

Type	Location	Offered for Use	Is It Under Repair
		Yes No	Yes No

Radios Owned

Type	Location	Call Sign	Fixed	Mobile	Offered for use	Are They Under Repair
					Yes No	Yes No
					Yes No	Yes No

In filling out this form, you certify that you are physically/medically fit to
perform in the areas in which you have indicated above that you are or want to be qualified.

Date