SchuylkillCounty IMT Type 5 -Candidate Application

Please complete the information below and then complete the additional steps below.

See Overview and Instructions portion for more details about the application process.

Name: ______

County of Residence: ______

Mailing Address: ______

______

Home Phone: Office Phone: ( ) ______

Mobile Phone: Pager: ( ) ______

E-Mail: ______

Company Affiliation ______

Current Employer: ______

Mailing Address: ______

Office Phone: ______

Supervisor’s Name / Title: ______

Please provide three references, other than your immediate supervisor, that we may contact to support your

Application for this position:

  1. ______Phone #______
  1. ______Phone #______
  1. ______Phone #______

Supervisor Approval: ______Date: ______

SchuylkillCounty IMT Committee Approval:

1. ______Date: ______

2. ______Date: ______

SchuylkillCounty Emergency Management Coordinator

Approval: ______Date: ______

What positions are you most qualified, or interested in being trained for? Please pick two, one Primary (P) and one Secondary (S).

IMT Chief / IMT Operations Section Chief
IMT Planning Sections Chief / IMT Logistics Section Chief
IMT Finance/Admin Section Chief / IMT Safety Officer
IMT Public Information Officer / IMT Liaison Officer
IMT Staging Manager / IMT Situation Status Unit Leader
IMT Service Branch Director / IMT Resource Status Unit Leader
IMT Support Branch Director / IMT Procurement Unit Leader
IMT Time Unit Leader / IMT Communications Officer

1. Provide documentation of qualifications, or a maximum one-page narrative demonstrating present / past Command experience and experience / training in the Areas you have chosen.

2. Provide certificates of proof of completion for Minimum required courses at the interview and any other Documentation that supports your eligibility for participation as a member of the IMT.

3. Please provide a letter of support from the head of your organization, explaining that they understand the program and will fully Support you in your best efforts to attend required meetings, trainings, exercises, and drills, and disaster deployments.

Please check all of the following courses that you have documentation for indicating that you completed the course.

IS-700 National Incident Management System; Introduction

IS-800 Introduction to the National Response Plan (NRP)

100 Level ICS course – Intro to ICS

200 Level ICS course – Basic ICS

300 Level ICS – Intermediate ICS

400 Level ICS – Advanced ICS

Incident Command System (NFA) or NIMS ICS for the Fire Service (NFA)

ICS for EMS (NFA)

ICS for Law Enforcement

Incident Safety officer

Introduction to Unified Command for Multi-Casualty and Catastrophic Incidents

(NFA)

Unified Command (NFA)

Introduction to Command & General Staff Functions in ICS

Command and General Staff Functions in the ICS

All Hazard Incident Management Team – Type 3 (NFA)

ICS for EmergencyOperationsCenter

Position Specific Training

Incident Commander

Operations Section Chief

Planning Sections Chief

Logistics Sections Chief

Finance/Administration Sections Chief

Liaison Officer

Safety Officer

Public Information Officer

Resource Unit Leader

Situation Unit Leader

Service Branch Director

Support Branch Director

Time Unit Leader

Procurement Unit Leader

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