Volunteer application - Salem County Office of Emergency Management

Name

First Middle Last

Title

Nickname

Address

Street Address Address Line 2 City State ZIP Code

Home Phone

Work Phone

Cell Phone

Email

Demographic Information

Please provide the information below in order to help us prepare for the upcoming course and assure we have all the needed items. Salem County Volunteer Program is open to all Salem County residents over 18 years old.

Date

Special Skills

Please let us know about any previous training or skills you have that you feel would benefit from you volunteering.

Volunteer Preferences

Community Emergency Response Team (CERT)
Medical Reserve Corp (MRC)
Other

Which area would you like to volunteer for:

Emergency Contact

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Home Phone

Work Phone

Cell Phone

Email

Terms*

I agree

My submission of this application attests that I am at least 18 years of age. All applicants will be required to successfully pass a criminal background check prior to membership. Volunteering is open to all Salem County residents. Admission to the Salem County Team after completion of the training is subject to approval of the Team Management upon submission of all appropriate documentation.

Name

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