CERT Application Restrictions: Must be 18 years of age or older A criminal background check will take place prior to acceptance as a volunteer Application Process: Please complete online and submit the completed application Attend 22 hours of core training Complete a criminal background check Volunteers: Are issued identifying items such as ID cards, caps, shirts or patches Receive local and national recognition and awards for outstanding volunteer efforts May receive positive recommendations for job applications Gain experience that may help in perusing job opportunities Receive training that teaches new skills and develops new interest Applicant Information: Name * First Middle Middle Last * Last Phone Number * Email * Mailing Address * Physical Address and/or Address Line 2 City, State, & Zip * City State * AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY State Postal Code * Zip Code How did you hear about us? Friend Newspaper Radio Already knew abou CERT Employment Information: Current Employment Status: * Employed Not Employed Retired Student Please provide the name of your employer: Employer Address: Employer City, State & Zip Code: City Employer State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Option 52 Option 53 State Employer Zip Code Zip Code Current or former occupation: Current or former volunteer work: Character References: Character Reference 1 Full Name Character Reference 1 Address Address Character Reference 1 City State Zipcode City, State and Zipcode Character Reference 1 Phone Phone Character Reference 1 Relation Relation Character Reference 2 Full Name Character Reference 2 Address Address Character Reference 2 City State Zipcode City, State & Zipcode Character Reference 2 Phone Phone Character Reference 2 Relation Relation Background: Have you ever been convicted of a crime? * Yes No Please explain why and status * By submitting this application you certify that the information is complete and true. You understand that references may be checked and a criminal background check will be processed following the first class. You understand that the Office of Homeland Security and Emergency Management (HSEM) is not obligated to assign you if, in HSEMs professional judgement, it would not be in your best interest, or the best interest of HSEM. OFFICE OF EMERGENCY MANAGEMENT Jim Barho, EMC Phone (512) 750-0507 Email firstname.lastname@example.org If you are human, leave this field blank.