Clark County Dept. of Emergency Management 
710 W 13th St; Vancouver, WA 98660-2810


Please complete this application form if you are interested in becoming a Clark County, WA volunteer. Once you complete the form, click the Continue button at the bottom.


Site


Name and address


Personal Information

This identification information is required for our records but is not visible on your card.



Background Check

A criminal history assessment will be conducted as part of the qualification and approval process for membership in CERT, CCSO SAR and ARES/RACES.  To help expedite this process please provide a brief (two to three sentence) explanation of any arrest or conviction in your past. The summary should include date of incident, jurisdiction (Local, State, Federal, Military), the charge, and how it was resolved. This information will be used to help in evaluating the results of the criminal history background check in order to determine suitability for service with CCSO SAR and ARES/RACES.  All applicants backgrounds are assessed; there are no ‘automatic’ disqualifications based on background check alone.



In the event of an emergency, please notify:


Verification of Information


Verification of Information

I understand that checking this box constitutes a legal signature affirming that the above entered information is true and accurate to the best of my knowledge.