Community Volunteer Application

All information will be treated confidentially. Please answer all questions as completely as possible.

This form is your expression of interest in joining CERT, and completing this form does not make you a member of CERT. Final acceptance is contingent upon a background check.

Personal Information
Emergency Contact
Group Affiliation
Availability
Licenses
Drivers and Professional
MinimalGood / SatisfactoryAbove Average / Expert
Accounting
Communication Systems Operations, e.g., Radio
Corporation/Agency Administration
Detail Orientation
Info Systems & Data Management
Interpersonal Communication
Inventory Control Process & Management
Supervision / Management
Leadership of Teams
Organizational Skills
Volunteer Management
NoneLess Then 3 YearsMore Then 3 Years
Dispensing Pharmaceuticals
Drivers License
Gov, EMA, Agency Official
Health / Medical Professional
Law Enforcement / Security
Maintenance / Custodial
Medical Physician
Medical Triage
Working With Special Needs Population
Training And/Or Public Speaking
Vaccination Logistics
Please tell us about your licensure and/or experience in the following areas, if any
What would be your first choice of division? For a description of each division, please click on the link above.
What would be your second choice of division? For a description of each division, please click on the link above.