Oregon Certified

OREGON CERTIFIED

EMERGENCY MANAGEMENT SPECIALIST

(ORCEMS)

(Name)

APPLICATION PACKAGE

FOR INITIAL CERTIFICATION

Revised: November 30, 2017

Note:

This application form is locked so that you can tab through the form fields and enter your information. To unlock the form to delete or add sections, click on the Developer Tab, select Restrict Editing, click on Stop Protection in the lower right hand column, enter the password ORCEMS and click OK. To relock the form, click on Yes, Start Enforcing Protection in the right hand column, reenter the password in both boxes and click OK.

Blank Page

ORCEMS CERTIFICATION

COVER SHEET

Name: / Current Position/Title:
Jurisdiction/Company: / Phone:
Address:
City:
State:Zip: / Fax:
E-mail:

Years in Current Position:

Years in Emergency Management

or Emergency Services:

I understand that my certification is subject to ORCEMS Subcommittee approval, and if granted, is current for a five-year period. I will execute the necessary documents and supply further information as requested by the Subcommittee. I understand that failure to supply the requested documentation and/or corrections by the date in the request letter, will result in my application being denied and returned. I understand that any false statement or misrepresentation I make in the course of these proceedings may result in the revocation of this application and the issuance of a complaint of violation.

I give permission for verification of any information contained in this package.

Applicant's Signature:

(Date)

Note:For current CEMs

Individuals that currently hold the CEM designation need to:

Provide proof of current CEM status
Enclose $75 application fee
Provide copy of PDS Certificate
Provide letter of recommendation from supervisor that includes confirmation of applicant being in current position for at least one year or the accumulation of hours equivalent of a year’s experience (approximately 2,000 hours) for applicants in part-time or volunteer positions.
If current position is outside of Oregon,
Provide three references that substantiate affiliation with Oregon-based stakeholders.
For each reference, provide name, agency, email and phone number as well as a paragraph explaining relationship.
Complete section III – Application Recommendation and Reference Requirement.
List four contributions to profession.
Three of the four (75%) must demonstrate an Oregon-based benefit.
Complete section V -Contributions to Profession.

ORCEMS CERTIFICATION

APPLICATION

Purpose

The Oregon Certified Emergency Management Specialist (ORCEMS) Program was created to raise and maintain professional standards in emergency management and to certify achievement of that standard within the profession within Oregon.

The program requirements were established with the intent that on achieving the ORCEMS designation, applicants will have also met at least 50% of the International Association of Emergency Manager’s (IAEM) Certified Emergency Manager application and recertification requirements.

General Information

All materials must be typed,unless otherwise specified, such as a signature.

Please delete any sections from this document that you don’t end up using. For example, there are two options under the “Experience” section. Delete the one you don’t end up choosing. The same applies to the “Contributions” section; delete the ones you are not submitting.

The form is locked to allow for you to tab through it to complete the forms. To unlock the form to add and delete sections, go to Review, Restrict Editing and click on Stop Protection in the lower right-hand corner of your screen. Enter the password “orcems” to unlock the document. To restart the protection, click on Yes, Start Enforcing Protection on the right-hand side of the screen and reenter the password.

Insert supporting documents behind the appropriate section/page so that the reviewers will know which requirement the documents support.

A Checklist with checkable boxes is provided in Attachment A, at the end of this document, for your convenience to track your progress. The checklist can be left off when you submit your application.

I.APPLICANT RECOMMENDATION AND WORK HISTORY - To satisfy this requirement:

Applicant must submit a letter of recommendation for certification from their current supervisor.

Supervisor writing letter of recommendation:

Name: / Position/Title:
Organization: / Phone:
Address: / Fax:
Email:

A.The supervisor’s letter should include a statement confirming that the applicant:

Has at least two years of continuing experience in emergency management.
Has been in the current emergency management related position for at least one yearor the accumulation of hours equivalent of a year’s experience (approximately 2,000 hours) for applicants in part-time or volunteer positions

B.Applicant must submit a copy of their CURRENT position description.

II.EXPERIENCE -- NOTE: complete either IIA. OR IIB. Please note which one you’ve chosen by checking the box in front of your selection.

To satisfy this requirement applicants must:

Demonstrate participation in a full scale exercise by (1) planning, (2) conducting or coordinating, and/or (3) having a major emergency management role during the exercise, OR

Experience in the response, recovery, and mitigation phases of an actual disaster.

APPLICATIONORCEMS CERTIFICATION

IIA. Experience - Exercise Participation (NOTE: complete either IIA. OR IIB.)

Date of exercise:

Describe the exercise (be specific and include objective/purpose):

Describe your role (be specific about planning, coordinating, and emergency management role):

Describe what you learned through your participation in this exercise [include comments about (1) mitigation, (2) preparedness, (3) response, and (4) recovery in addition to other learning points:

IIB. Experience - Actual Emergency Management Participation in Disaster or Emergency, as applicable (NOTE: complete either IIA. OR IIB.)

Describe activity (be specific including date, type and area affected, loss of property and lives, and other significant factors):

Describe your involvement (be specific about your role in emergency management activities (paid/volunteer), including response and recovery, during the disaster or emergency):

Describe your recommendations for future mitigation activities that should be undertaken, as they relate to preparedness, response, and recovery, as a result of lessons learned from the disaster or emergency (Use additional sheets as necessary):

APPLICATIONORCEMS CERTIFICATION

III.APPLICANT REFERENCE REQUIREMENT

Applicants must submit the names of two references*, and information on their reference sources as requested below. NOTE: Applicants are encouraged to inform references that they have been listed. Certification Committee members, at their discretion, may call references to verify information.

*If your job is outside Oregon, provide three references that substantiate affiliation with in-State stakeholders and include a paragraph explaining the relationship/relevance to emergency management in Oregon.

A.Reference sources that qualify are:

A past supervisor (within 7 years)
Local, state or federal government officials or department heads
Emergency service organization officials (e.g., public, private, military, tribal, etc.)
Local, regional or national emergency management association officials
Others (by request to and approval of Certification Commission)

B.Reference sources that do not qualify are:

A subordinate

Friends, relatives or neighbors

A former student

Supervisor writing letter of recommendation

1.Reference

Name: / Position/Title:
Organization: / Phone:
Address: / Fax:
Email:
If position is outside Oregon, explain relationship with reference:

2.Reference

Name: / Position/Title:
Organization: / Phone:
Address: / Fax:
Email:
If position is outside Oregon, explain relationship with reference:

3. Reference (Only required if outside of Oregon)

Name: / Position/Title:
Organization: / Phone:
Address: / Fax:
Email:
If position is outside Oregon, explain relationship with reference:

APPLICATIONORCEMS CERTIFICATION

IV.EDUCATION AND TRAINING REQUIREMENTS

Applicants must:

Provide High School Diploma, GED Certificate, or other higher education degree diploma

Documentation provided:
Document Date:

Have completed PDS and provide a copy of the certificate of completion.

PDS certificate date:

Demonstrate successful completion of 50 classroom hours of emergency management training and 50 classroom hours of general management training. A single topic/subject cannot account for more than 25 percent (13 hours) of the total number of hours required for that category of training. Example: An individual who has attended ICS 100, ICS 200, ICS 300, and ICS 400 will be credited with no more than 13 hours of Emergency Management related training.

Complete the Summary of Training forms (separate forms for Emergency Management Training and for General Management Training) that reflect the total training courses you’re submitting for qualification. These forms must be grouped under topic or subject areas (limit of 25% in one subject area). These summarize your training and ensure that the training does not exceed 25% in each of the subject areas.

Complete a detailed Training Submission form for each training activity. While there is no time restriction on training submissions, Applicants should select the most current training possible. An Applicant should not reflect his/her entire training history, but please provide ample training listings in the event the review panel finds a submission ineligible.

NOTE: Course work applied to the PDS certificate of completion requirement cannot be used for any portion of the emergency management or general management training requirements.

Workshop, Seminar and/or Course Source Requirements

Training sources which may qualify for submission are:

Federal Agencies (FEMA, NFA, EMI, EPA, DOT, DOE, Military, etc.)
State and Local Agencies
Regionally Accredited FourYear Institutions
Regionally Accredited TwoYear Institutions
VendorSponsored Courses
Military Programs
Private Organizations
Professional Societies/Organizations/Associations
Other

The following Professional Development Series (PDS) courses are NOT eligible for submission since they are part of a separate requirement:

Introduction to Emergency Management/ Principles of Emergency Management
Basic Skills 1: Leadership and Influence
Basic Skills 2: Decision Making and Problem Solving/ Decision Making in a Crisis
Basic Skills 3: Effective Communications
Basic Skills 5: Developing Volunteer Resources
Emergency Planning Course
Exercise Design Course

Breakout sessions attended during conferences cannot be used to fulfill a training requirement. Pre- and Post- Conference training sessions can count provided they have a certificate or other proof of attendance. Professional Conference attendance can be used under the Contributions to the Profession portion of the application.

Course/Program Content

A syllabus, catalog description of the course, or a written description of training content must also accompany each Training Submission Form. The National Emergency Training Center (NETC) in Emmitsburg, Maryland provides course descriptions and classroom hours in NETC, EMI or NFA course catalogs; they also include equivalent hours for Home Study or Distance Learning Courses. Both EMI and Oregon Emergency Management can provide student transcripts, upon request, for courses they have hosted.

Training Hours

Each Training Submission Form must be accompanied by a college or FEMA (Region, State, EMI or NFA) transcript, certificate of completion, or other acceptable documentation from the institution that conducted the training. Documents used for verification must show date of completion, title of training and number of classroom hours earned.

If the training certificate provided as proof of completion, does not include hours, then it is the applicant’s responsibility to provide independent verification (i.e. copy of training catalogue or a letter from the organization teaching the course) of training hours for courses which they are seeking credit.

* Note: One college credit equals 12 hours; one continuing education unit (CEU) equals10 hours.

APPLICATIONORCEMS CERTIFICATION

3.1.SUMMARY OF TRAINING HOURS FORM

Emergency Management Training

Requirement: 50 hours of training, not more than 25% (13 hours) in one subject area.

Samples of Workshop, Seminar and/or course subject matter acceptable for submission:

Criminal Justice/Law Enforcement
Disaster Preparedness
Emergency Medical Training
Emergency Operations Centers
Emergency Planning and Crisis Mgt.
Exercise Courses (Other than Exercise Design)
Fire Technology
Hazard Analysis & Capabilities Assessment
HazMat Mgt. and Hazards Assessment
Health, Safety and Environment Mgt.
Incident Command Courses
Medical Technology

Physical Sciences
Public Information
Radiological Monitoring, Detecting, etc.
Safeguards and Security
Safety Technology
Shelter Management
Technology, Equip. and Info. Systems
Training and Instruction
Urban/Wilderness Search and Rescue
ICS/EOC Integration
Managing Search Operations
Managing Emergency Operations
Disaster Recovery Courses
Military Courses
Red Cross Courses

Complete a Training Submission Form for each item on this sheet. Remember each entry requires proof of attendance.

Note: One college credit equals 12 hours; one continuing education unit (CEU) Equals 10 hours.

Emergency Management Training

TITLE OF TRAINING COURSE / TOTAL HOURS / ALLOWABLE HOURS
SUBJECT 1
SUBJECT 2
SUBJECT 3
SUBJECT 4
SUBJECT 5
SUBJECT 6
SUBJECT 7
SUBJECT 8
SUBJECT 9
SUBJECT 10
TOTALS:

Please insert Training Submission Forms in the order they are reported on this form, with documentation behind each Submission as they are presented.

You may duplicate this form if necessary.

3.1.a.TRAINING SUBMISSION FORM for Emergency Management

Subject #

A)Training title and number (number where applicable):

B)Training source:

C)Training date:

D)Training length (in hours):

E)Training content summary (You may instead attach a copy of the catalog or other printed description of the course or a syllabus):

REMEMBER:

No more than 25% (13) hours can be from one topic/subject
A college or FEMA transcript, certificate of completion or other acceptable documentation from the institution that conducted the training is needed for each training submission.
Documentation must show the number of classroom hours (or college credits for a college course) for the training.
If the course certificate does not include hours, then additional documentation/proof will be required.

-- REPRODUCE THIS FORM AS OFTEN AS NECESSARY --

APPLICATIONORCEMS CERTIFICATION

3.2.SUMMARY OF TRAINING HOURS FORM

General Management Training

Requirement: 50 hours of training, not more than 25% (13 hours) in one subject area.

Samples of Workshop, Seminar and/or course subject matter acceptable for submission:

Behavioral and Social Sciences
Business Communication: Written and Oral
Ethics
Executive and Management Development
Financial Management and Budgeting
Grantsmanship (Development, Evaluation and Reporting)
Principles of Management
Diversity in the Workplace

Human Resources
Personnel Management
Marketing and Public Relations and Media Management
Race and Ethnic Relations; Intercultural Communications
Strategic and Tactical Planning
Technology, Equipment and Information Systems
Organizational Behavior
Public Speaking

Complete a Training Submission Form for each item on this sheet. Remember each entry requires proof of attendance.

Note: One college credit equals 12 hours; one continuing education unit (CEU) equals 10 hours.

General Management Training

TITLE OF TRAINING COURSE / TOTAL HOURS / ALLOWABLE HOURS
SUBJECT 1
SUBJECT 2
SUBJECT 3
SUBJECT 4
SUBJECT 5
SUBJECT 6
SUBJECT 7
SUBJECT 8
SUBJECT 9
SUBJECT 10
TOTALS:

Please insert Training Submission Forms in the order they are reported on this form, with documentation behind each Submission as they are presented.

You may duplicate this form if necessary.

APPLICATIONORCEMS CERTIFICATION

3.2.a.TRAINING SUBMISSION FORM for General Management

Subject #

A)Training title and number (number where applicable):

B)Training source:

C)Training date:

D)Training length (in hours):

E)Training content summary (You may instead attach a copy of the catalog or other printed description of the course or a syllabus):

REMEMBER:

No more than 25% (13) hours can be from one topic/subject.
A college or FEMA transcript, certificate of completion or other acceptable documentation from the institution that conducted the training is needed for each training submission
Documentation must show the number of classroom hours (or college credits for a college course) for the training.
If the course certificate does not include hours, then additional documentation/proof will be required.

-- REPRODUCE THIS FORM AS OFTEN AS NECESSARY --

APPLICATIONORCEMS CERTIFICATION

APPLICANT'S PROFESSIONAL CONTRIBUTIONS TO AND SUPPORT OF THE FIELD OF EMERGENCY MANAGEMENT

Please submit activities for at least four (4) of the listed categories to meet this requirement.

List any and all activities relative to the categories listed below; giving special consideration to the most current activities.

Submit documentation of activities such as a letter, certificate, or other proof of activity.

Please provide contact information when requested. This will be checked at the discretion of the Certification Committee members.

Submissions must contribute to and support the field of Emergency Management in Oregon.

Submissions for contributions that have (*) after the titlemust be beyond the scope of your normal job responsibilities. (i.e., If you are a local Emergency Manager and are responsible for teaching ICS courses to your county/city staff, those trainings cannot be used as a contribution to the profession for Teaching. If you teach a regional or state level course that is open to people outside your county/ city; that is an appropriate contribution to the profession.)
Please expressly state how the activity was outside of your normal job duties.

Applicants are encouraged to submit multiple examples where possible.

All information must be submitted on the appropriate form; candidate may duplicate forms for multiple submissions and utilize additional pages as necessary.

If applicant resides/works outside of Oregon, three of the four contributions (75%) must demonstrate an Oregon-based benefit.

The acceptable categories for submissions are listed below.

Checkable boxes are provided for your convenience to highlight which sections you’ve chosen as well as to aid reviewers in scoring your application.
Please delete any sections that you don’t end up using. Do not include blank pages.

A. Membership (*):