LCEMA Volunteer Interest Form Question Title * 1. Contact Information Name * Address * Address 2 City/Town * State/Province * ZIP/Postal Code * Email Address Home Phone * Cell Phone * Question Title * 2. What is the best way to reach you? Home Phone Cell Phone Email Question Title * 3. What are your volunteer interests? 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 PPE Distribution and Warehouse Operations Search and Rescue Other (please specify) Question Title * 4. What days of the week are you available to volunteer with LCEMA? Monday Tuesday Wednesday Thursday Friday Saturday Sunday Question Title * 5. What type of volunteer commitment to LCEMA is right for you? Annual pre-planned event A few times a year About once a week A few days per week Question Title * 6. What ICS training courses have you completed? #1 #2 #3 #4 #5 #6 #7 #8 Question Title * 7. Do you have any previous volunteer experience with any other agencies? No Yes If yes, please briefly explain. Question Title * 8. Do you have any professional certifications, memberships, or licenses? (Ex: CPR certified or IPEM) No Yes If yes, please explain. Question Title * 9. Do you have any experience in teaching training courses? Yes No If yes, please specify the course Question Title * 10. How did you hear about volunteering with LCEMA? Friend/ Family Member Internet Volunteer flyer/ fair LCEMA Staff Member Staff member name Question Title * 11. Please use this space to share any other details about your interest in volunteering with LCEMA. Done
