Field and Community Response Team Application

IDAHO DEPARTMENT OF CORRECTION
Field and Community Response Team Application
Note: Applicants must not be serving an employment probationary period.
Personal Information
Applicant's Name (First, MI, Last):
Associate ID#: District/CWC: --Select-- Hire Date:
Primary Occupation:
Home Street Address:
City& State: Zip:
Home Ph: Work Ph: Other Ph:
Personal Email Address:
Work Email Address:
Emergency Notification Information
Contact's Name (First, Last):
Relationship to You: --Select--
Home Street Address:
City& State: Zip:
Home Ph: Work Ph: Other Ph:
Questionnaire
1. Statement of Interest
Why do you want to be a member of a Field and Community Response Team?
2. Emergency Experience
A. Please describe any difficult or noteworthy past experiences you have had with providing emergency
services.
B. Do you have experience as an emergency response team member? Yes No
C. If you answered `yes' to `2B', please list the types of emergencies you were involved in as a team member.
Appendix A Page 1 of 3
709.04.02.001
(Appendix last updated 6/29/11 )

Applicant's Name (First, MI, Last): Associate ID#:
3. Willingness and Abilities to Instruct
Discuss your willingness and abilities to instruct and provide education about emergency management to either
individuals or groups.
5. Describe Yourself
Describe your strengths and weaknesses.
6. Membership in Professional Organizations
A. Are you a member of any professional organizations? ❑Yes ❑No.
B. If you answered `yes' to `6A', please list their names and indicate whether your membership is current.
7. Participation in Community Service Groups and Programs
List any community service groups and programs in which you have participated (e.g., Red Cross, Volunteer
Fire, EMT, Sheriff's Search and Rescue, etc.).
8. Related Training
List and describe any training you have received in the areas of emergency management. Please include
conferences, seminars, courses, certificates, etc. Please list a few examples that are relevant to FCRT
membership (e.g., ICS 100, 200, 300, 700, tactical team training, etc.).
9. References
List three (3) references who will acknowledge your interest and abilities to be an effective FCRT member.
Name Relationship to You Phone Number
Signature Date
Note:After completing and signing, forward to your immediate supervisor for a recommendation.
Appendix A Page 2 of 3
709.04.02.001
(Appendix last updated 6/29/11 )

Applicant's Name (First, MI, Last): Associate ID#:
Recommending Authority
❑ Recommended ❑ Not Recommended
If not recommended, reason:
Immediate Supervisor's Signature Date
Selection Authority
❑ Selected ❑ Not Selected
If not selected, reason:
District Manager's Signature Date
Appendix A Page 3 of 3
709.04.02.001
(Appendix last updated 6/29/11 )