Disaster Response Team Application

Thank you for your interest in Heart to Heart International's Disaster Response Team (DRT). Upon completion of this application, additional instructions will be provided. We will review your application and supplements once all documents have been submitted.

Please read the following carefully:

The application process timing varies depending on the time taken to submit supplemental paperwork and the availability of HHI staff to interview and review applicants. The process takes longer during disasters as HHI staff are deployed to the field. During times when HHI is not responding to disaster this process might take two weeks, during an active disaster response this process could take two or more months.

All Disaster Response Team members are subject to criminal and credential background checks.

At this time, we are not deploying LPNs or EMT/Paramedics in a clinical role. However, you can apply as a non-medical logistics volunteer.

If you have any questions along the way, please check out our FAQs page. If you have additional questions, please email Gabby, gabby.martinez@hearttoheart.org.

Contact & Demographic Information

Where it asks for password, please choose a password to use for VicNet/Volgistics, which is how you will log on to our volunteer management database to submit paperwork, log volunteer hours, etc.

First name:

Last name:

Middle name:

Title:

Name exactly as on Passport:

Street 1:

Street 2:

Nearest Airport:

City:

State:

* Zip / Postal Code: *

Country:

Best Contact phone:

Work phone:

Cell phone:

OK to call me here

Employer phone:

Home phone:

Email address:

Please enter a password that:

Is between 6 and 30 characters long

Password:

Confirm password:

Date of birth:

(year optional)

Gender:

T-Shirt size:

How did you hear about us?:

* Primary Language:

English

French

Other

Spanish

Secondary Language(s):

English

French

Other

Spanish

* Please rate your proficiency of your additional languages as: Fluent, Good, Fair or Basic.

Education

Please indicate your highest level of education.

Education:

DRT Position Applying for:

Please only select medical positions if you have certification in that area. If you're not sure which position to select, or you don't have a medical license, please select Logistics Domestic and/or International.

Credentials

Please select the appropriate medical certifications and specialties. Please ensure you select ALL states that you are currently licensed in.

If you are applying for a non-medical position, please select none and complete the additional skills portion below.

Additional Medical Specialties

i.e. tropical medicine, public health, epidemiology, OB/GYN, C-Section, pediatrics, accident and emergency (trauma, infectious diseases, HIV/AIDS, STDs, TB, general practice, minor surgery, etc. Write N/A if none.

*Fields adjust to AutoFit as needed for content. No limit on word count.

Application Questions

Why are you interested in volunteering with Heart to Heart International?

Technical Skills & Experiences

Any non-medical skills - i.e. pumps and generators, motor vehicles, energy and electricity, radio equipment, construction and building, cold chain, water and sanitation, bookkeeping, etc. Write N/A if none.

*Fields adjust to AutoFit as needed for content. No limit on word count.

Computer Skills & Experiences

i.e. software, hardware, internet, website design, programming, etc. Write N/A if none.

*Fields adjust to AutoFit as needed for content. No limit on word count.

Volunteer Experience

List any experience working with a volunteer organization either in a developing country, domestic disaster or administrative context. Write N/A if none.

*Fields adjust to AutoFit as needed for content. No limit on word count.

Emergency Contacts:

1

2

First name:

Last name:

Middle name:

Nickname:

Street 1:

Street 2:

City:

State:

Zip:

Home phone:

OK to call here

Home phone:

OK to call here

Work phone:

OK to call here

Work phone:

OK to call here

Cell phone:

* OK to call here

Cell phone:

* OK to call here

Email address:

Relationship:

Please note the name of your travel beneficiary.

References

Please provide the following references:

1. Work Supervisor Reference

2. Co-Worker Reference

3. Personal Reference

4. Volunteer Service Team lead (if applicable)

If self employed, we will still need a minimum of 2 professional references.

1

2

Employer name:

First name:

Last name:

Title:

City:

State:

Work phone:

Cell phone:

Email address:

Relationship:

3

4

Employer name:

First name:

Last name:

Title:

City:

State:

Work phone:

Cell phone:

Email address:

Relationship:

Volunteer Handbook Agreement

Please review the Volunteer Handbook.

I have read and agree to uphold the policies outlined in the Heart to Heart Volunteer Handbook: https://hearttoheart.org/volunteerhandbook

I Agree