Please complete this application form only if you are interested in becoming an official CERT/AuxCom/MRC volunteer with Marion County Emergency Management.

As an official volunteer with these specialized teams, you will be expected to attend regular meetings, stay up to date on training and be available for occasional team response in the community. If you are only interested in receiving training but not interested in becoming a regular team member, please DO NOT fill out this form. (You do not have to be an official volunteer to participate in community training.)

Once you complete the form, click the CONTINUE button at the bottom.

Contact Information

First name:

Last name:

Nickname:

Street 1:

Street 2:

City:

State:

Zip:

Home phone:

OK to call me here

Work phone:

OK to call me here

Cell phone:

OK to call me here

Ok to text?:

First name:

Last name:

Home phone:

Cell phone:

Relationship:

E-mail

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however we will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.

Email address:

What kinds of email would you like to receive?

Recruitment appeals

General Correspondence

Schedule reminders

Why do you want to volunteer?

Do you have a certain skill/talent you want to share? Are you hoping to develop skills and learn new things? Do you just want to help your community? Please share the reasons why you are interested in volunteering.

Assignment Preference

Which team are you interested in volunteering with?

Specify CERT team (ESSNA, Keizer, Mt Angel, North Marion, Silverton, Stayton, Woodburn), ARES, or MRC

Skills & Experience

In which areas do you feel you have moderate to excellent skill? List all that apply.

Education/Special Certifications

List all that may apply. (If you are an Amateur Radio Operator, please include call sign).

Previous Volunteer Experience

Have you volunteered in other organizations? If so, where and what did you do?

Employer

Please list your current or most recent employer, if applicable.

Employer name:

Street 1:

City:

State:

Zip:

Demographic Information

You may optionally provide the following information. Some of our volunteer positions require a minimum age; date of birth is only used to match to appropriate volunteer positions.

Date of birth:

(year optional)

18 or Older:

12-17 yrs old Permission Form Required:

I Agree

I understand that submitting this application form does not automatically register me as a Marion County volunteer and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures, before I may begin volunteering.

By submitting this form, I agree that the information I have provided on the form is true and accurate.

I Agree