Seattle Medical Services Team (MST)

Please complete the following information (due to the sensitive and secure nature of City of Seattle emergency information and facilities all applications will be required to undergo a basic criminal records check.)

Check One: New Application
Renewal
Current ID Badge #
Personal Information:
Last Name
First Name
Middle Initial
Date
Amateur Radio Call Sign
Occupation/Employer
Residence Address:
Street
City
State
Zip Code
Mailing Address:
Street
City
State
Zip Code
Home Phone
Work Phone
E-Mail
Pager
Service Provider
Alphanumeric Yes No
State Emergency Worker Information:
Date of Birth
Height
Weight
Hair Color
Eye Color
Person to Contact in Case of Emergency
Relationship
Emergency Contact Home Phone
Emergency Contact Work Phone
Comments or questions:
I certify that I have read the Personal Responsibilities of Emergency Workers section (118-04-200) of WAC 118-04 and the mission/purpose statement of MST hereby agree to comply with the requirements and I certify that this is my true identity and acknowledge that the City may check criminal records systems for any criminal history. Findings of criminal records may or may not be grounds for disqualification from membership and will be reviewed case-by-case.

Please mail signed form to:
Seattle EOC
ACS/MST Application
2320 4th Avenue
Seattle, WA 98121-1718

Questions? Please contact Marina Zuetell Phone 206-524-6567