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LCEMA Volunteer Interest Form
This survey is to capture your interests in volunteering with LCEMA. Once completed, the Volunteer Coordinator will reach out to you with the next steps. Thank you for completeing this survey!
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1.
Contact Information
(Required.)
Name
*
Address
*
Address 2
City/Town
*
State/Province
*
ZIP/Postal Code
*
Email Address
Home Phone
*
Cell Phone
*
*
2.
What is the best way to reach you?
(Required.)
Home Phone
Cell Phone
Email
*
3.
What are your volunteer interests?
(Required.)
Pre-Planned Community Events- (Ex: Lake County Fair)
Assisting in the Emergency Operations Center (EOC) in an emergency
Community Outreach/ Engagement- Presentations
Participation in Exercises- Observer or Evaluator
Health department tasks/ Point of Dispensing (PODS) locations
Inventory Organization/ Management
Search and Rescue
Other (please specify)
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4.
What days of the week are you available to volunteer with LCEMA?
(Required.)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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5.
What type of volunteer commitment to LCEMA is right for you?
(Required.)
A few days a week
About once a week
Monthly
Annual pre-planned events
6.
List any ICS courses you have completed if any.
#1
#2
#3
#4
#5
#6
#7
#8
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7.
Do you have any previous volunteer experience with any other agencies?
(Required.)
No
Yes
If yes, please briefly explain.
*
8.
Do you have any professional certifications, memberships, or licenses? (Ex: CPR certified or IPEM)
(Required.)
No
Yes
If yes, please explain.
*
9.
Do you have any experience in teaching training courses?
(Required.)
No
Yes
If yes, please specify the course
*
10.
How did you hear about volunteering with LCEMA?
(Required.)
Friend/ Family Member
Internet
Volunteer flyer/ fair
LCEMA Staff Member
Staff member name
11.
Please use this space to share any other details about your interest in volunteering with LCEMA.
