Florida Forest Service
Florida Interagency INCIDENT Management Team
Application
SECTION I – PERSONAL INFORMATION
NAME / title / CURRENT EMPLOYER / DATECOMPLETE work ADDRESS / CONTACT INFORMATION (Telephone & Email)
Work: / Fax:
Cell: / Email:
REFERENCES (Please provide three (3) references)
Name / Title / Phone / Email
POSITION(S) APPLIED FOR / QUALIFICATION verification (office use only)
1. / Qualified / Trainee
2. / 1. / 1.
3. / 2. / 2.
4. / 3. / 3.
5. / 4. / 4.
PLEASE INDICATE COMPLETED ICS TRAINING COURSES (Attach IQS master record to application to verify work experience & qualifications)
ICS-100 Introduction to ICS / ICS-400 Advanced ICS / All-Hazards Incident Management Team (IMT)
ICS-200 Basic ICS / IS-800a Introduction to the NRP
ICS-300 Intermediate ICS / S-420 Command and General Staff
SECTION II – AGREEMENTS
the undersigned hereby agree to the following:
My employing agency will:
· Allow me the opportunity to participate on a Florida Interagency Incident Management Team and will provide personnel when possible to cover my ordinary shift when I am participating in Incident Management Team activities.
· Will provide salary, insurance and other fringe benefits for the duration of the Incident Management assignment.
· Will provide transportation as necessary to and from the assignment within the State of Florida bearing the responsibility of providing insurance, maintenance and expenses for transportation.
Immediate Supervisor’s Signature & Date / Applicant’s Signature & Date
The Florida Department of Agriculture and Consumer Services, Florida Forest Service will:
· Provide meals and lodging for the team member for the duration of the assignment.
· Provide materials and supplies, including Personal Protective Equipment (PPE) for the duration of the assignment.
· Ensure that the Incident Management Team regular deployment should not exceed 14 days, without notification and approval from the employing agency.
Forest Protection Bureau Chief’s Signature & Date / Field Operations Bureau Chief’s Signature & Date