Skip to content
LCEMA Volunteer Interest Form
*
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)
*
4.
What days of the week are you available to volunteer with LCEMA?
(Required.)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
*
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
*
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.
