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Indicate the team or teams for which you are applying for membership:
Describe any employment history that you feel would be relevant to this application.
Describe any educational history that you feel would be relevant to this application
Describe any previous volunteer experience or involvement.
Mark any FEMA / NIMS classes completed.
If you completed the prerequisite 20-hour CERT Class through someone other than Butler County Emergency Mgmt, provide the dates and location of your CERT Class (you will also be asked to provide a copy of your completion certificate prior to finalizing your placement).
Mark any active medical certifications or qualifications that you currently possess (do not include lapsed or expired certifications).
Mark any active firefighting or rescue certifications or qualifications that you currently possess (do not include lapsed or expired certifications).
Mark any active law enforcement certifications or qualifications that you possess (do not include lapsed or expired certifications).
Mark any additional active certifications or qualifications that you possess.
List any other qualifications that you feel would be relevant to this application. Feel free to elaborate on any of the items marked above, as well.
The CERT team is broken into seven functional areas, giving participants a variety of ways to serve and be involved. Indicate the groups in which you are interested in participating.
Have you ever been convicted of and/or placed on probation for a criminal or traffic offense?
Please note that by clicking "agree," you have signed this application, indicating that you understand, acknowledge and agree to the following conditions:
1. Butler County Emergency Mgmt is under no obligation to accept any applicants to its volunteer teams.
2. A background check may be conducted prior to placement into a volunteer position.
3. Any false statements or misrepresentation on this application will be cause for refusal of placement or immediate dismissal at any time during placement.
4. Volunteers affiliated with County departments are held to the same standards and policies as County employees, including standards and policies on public conduct, use of County equipment, use of controlled substances, harassment, etc. Applicants agree to abide by all volunteer program and County policies; failure to do so will be cause for dismissal from the program.
If you have any questions related to the application, please contact Butler County Emergency Management at (316) 733-9796.
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