Operations and Planning
Disaster Recovery and Mitigation
Homeland Security Program
Training and Exercise
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Get Ready, Get Set, Get Safe
County/Tribal Emergency Management
Section 1: Personal/Work Information
* First Name:
* Last Name:
* Job Title:
* Work Address:
* Home Address:
* Home Phone:
* Work Phone:
* Cell Phone:
* Email Address:
Can you commit to:
4-5 days of initial IMAT training?
Availability for IMAT training/exercising one or twice a year?
Incidence response outside your local jurisdiction?
Incidence response duration from 1 day to 10 days?
* Current Employer:
* Current Position:
* Name of Supervisor:
* Supervisor Position:
* Supervisor Home Phone:
* Supervisor Work Phone:
* Supervisor Cell Phone:
* If you are a volunteer responder, list organization(s) you actively respond for:
Section 2: Position Applying For
List the Positions you are most qualified for and interested in order of importance.
Section 3: Training Completed
E.g. ICS 100, 200, 300, 400
E.g. Decon Instructor - trained at level A, B & C Hazmat responses. Current Operations Level Haz Mat Certified.
Section 4: Personal Experiences
E.g. I was the Operations Officer for the 2001 passenger train derailment on MT/ND border 160 passengers - fatalities and critical patients.
E.g. I was the incident commander during the 2009 flood response for Dakota City.
E.g. I was fire chief for the Dakota City Fire Department from 2002-2009.
Your application will be reviewed to determine if you meet the initial IMAT qualifications and if you are needed to serve at this time. If you meet the initial criteria, you will be notified and the Department of Emergency Services will discuss the other steps in the process. These steps include an interview and orientation, employer confirmation, a background check, and training courses for the position your are requesting.
I certify that all information contained in this application is true and complete to the best of my knowledge. I understand that any willful misrepresentation, false statement, or omission by me in the application or interview process will be cause for rejection of my application or termination of my employment. I authorize investigation of all statements made on this application. I authorize ND Department of Emergency Services to contact my references and verify the information that is obtained. I release all persons, companies, and organizations from liability for providing or receiving such information. I further understand that this employment application and other employment related documents are not contracts of employment; and, that any oral or written statements to the contrary are hereby expressly disavowed. I hereby acknowledge that if offered a position with ND Department of Emergency Services, my appointment will include a probationary period of a minimum of six months.
This site updated as of 7/28/2014.
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