Name

Address

City State Zip

Email

(One phone number is required. Your choice of which one. Area code is required.)
Home Phone

Cell Phone

Work Phone

Home Church

List Occupation, interests, hobbies and/or skills.

List two personal references (include name, addresses, phone numbers and length of acquaintance):
Personal Reference 1:

Personal Reference 2:

Your availability schedule (weekends only, certain week days, all days, etc):

Do you have a CDL? Yes No

Do you have a chauffeur's drivers license? Yes No

Do you have special needs that would qualify you to work in certain areas but not others? If so, please list:

Areas of Experience (check all that apply):

Chain Saw training. Length of experience Rate Your skill level 0 - 10 ( 0 being none)

Experienced in sharpening chains on the job.

I am interested in being a team leader.

I am comfortable falling trees.

I am more comfortable hauling and stacking brush.

I have my own equipment that I would be willing to use.

Please list:

I have office experience

I am a Ham radio Operator:
Call Sign: Years of experience
Current license level: Novice Technician (including Tech+) General Advanced Extra

I have two-way radio experience.

I would like to work as a dispatcher for the teams.

I have good computer skills. In Excel, Microsoft Word, Word Perfect.

I have good map reading skills.

I have good note taking skills.

I have courteous phone skills.

I have good organizing and filing skills.

Mobile Kitchen

I feel comfortable helping in food preparation.

I have maintenance skills to make sure everything is working and all gas levels are filled.

I know how to set-up and level the mobile kitchen unit.

I have experience in inventory control (purchase and transport food and supplies).

I am willing to be a dishwasher.

I am willing to be a part of the the cleanup crew.

other

Chain Saw Response Team Training

Communication Team (including Ham and two-way radio)

Crisis Care

Donated Goods Management

       Donation Operations

       Warehouse Management (pre-requisite required)

Forklift Driver for Warehouse Operations

Introduction to Disaster Preparedness Class

Mobile Kitchen Team

Your goals desires and past experience.

What area would you like to be involved in?

Other disasters you have volunteered for. Please list.