Instructions for Filling Out Application Electronically and Submitting
Typing in fields:
Click on the line after any empty section (i.e. Last Name). A box will be highlighted.
Type information, then press Tab. This should highlight the next field to be filled out. Using this method should prevent you from missing any necessary fields.
***There is also the option of simply going through and clicking on areas that need to be filled.***
Making checkmark selections:
- Left click on the box you want to select.
OR - Press the space bar after highlighting the desired box using the Tab method.
Please note that if you cannot select an area on the application it is not meant for you to fill out.
Final Review (After filling out the forms)
To ensure all required fields are filled out, start by selecting the Last Name field on the Volunteer Application. Then press Tab multiple times until you reach the end of the document. This will show you if you have missed any areas that are not obvious on the forms.
Printing and Sending
- Because it is necessary to sign several pages, print off completed application after reviewing
- Sign forms where necessary (Signature is needed on the Volunteer Application, WSP Background Check, Applicant Disclosure, Emergency Worker Registration Card, Confidentiality Agreement, and Image Release)
- Mail to:
Pierce County Medical Reserve Corps
Attn: Vi Vo
3629 South D St. MS 111
Tacoma, WA 98418
OR - Fax to: (253) 798 –7627
include a copy of your driver’s license. This is needed to complete the background check
Thank you for willingness to volunteer for the Pierce County Medical Reserve Corps!
TACOMA-PIERCECOUNTYHEALTHDEPARTMENT
EMERGENCY WORKER REGISTRATION PROCEDURES
1.AUTHORITY:
Registration isa prerequisitefor eligibility of emergency workersforbenefits and legal protection underchapter 38.52RCW.
(1) Emergency workersshall registerintheirjurisdictionof residenceor inthe jurisdiction wheretheir volunteer organizationisheadquartered by completingand filing anemergencyworkerregistrationcard,FormEMD-024 orequivalent, withthelocal emergency management agency.(WAC 118-04-080)
2.PROCEDURES:
a.Eachindividual whowishesto beregisteredas an emergency worker with the Tacoma-Pierce County HealthDepartmentmust fill out aWashington State EmergencyWorker Registration Card (FormEMD-024).The information provided onthiscard will beused by the WashingtonStatePatrol toconduct aCriminal History andDrivingRecord background check. The information determinedduringthisbackground investigationwill beusedto determine the suitability for issueof aWashington State EmergencyWorker Registration Card. (WAC 118-04-080 (a)).
b.Failure totruthfully respondtothe statementsset forthin the certificate in paragraph 3 below may result in denial ofaWashingtonStateEmergencyWorker Identification card. (WAC
118-04-080)
c.Uponsatisfactoryresults fromthe backgroundcheck,theissued card will bevalid for three years. At the end of two years, anew application must bemade inorder to receive an up- datedcard.The same Pierce County EmergencyWorkernumber will bere-issued. (WAC
118-04-080)
d.If a volunteer card expires and is not renewed within ninetydays, thevolunteer will be dropped fromtherolls.Volunteerswithan expired card will not beafforded protection and reimbursementas described underRCW 38.52 and WAC 118.04.080.
e.Temporary registrationof volunteers may be accomplishedfor shortdurationsif they have filledout a temporaryregistrationcard which includesname, dateofbirth and address. (WAC118-04-080) Registrants willnotbeissued an identificationcard but will beafforded thesame protection underRCW 38.52and WAC 118.04 as afully registered volunteer.
f.An employee of the state orof a political subdivision of thestate whoisrequired to perform emergencydutiesasanormalpartoftheirjobshall beconsideredasregistered with the local emergency management agency inthejurisdictionin which they reside.(WAC118-04-080)
g.When suchindividualsare outsidethe jurisdictionoftheiremployment duringadisaster or emergency, except whenacting under theprovisionsof amutual aid agreement, they should report totheon-sceneauthorizedofficial andannouncetheir capabilities andwillingness to serve as a volunteerduringthe emergency ordisaster.These individualswill be afforded the same protectionasall otheremergency workers. (WAC118-04-080)
Lastmodified 11/4/2008 1:23 PM1
3.CERTIFICATE
I(pleaseprint your name),, certify that:
Iaminadequate physical conditiontocarryout theemergency workerassignment given tome andthatIamnot subject toany medical problems orotherinfirmity of bodyor mind,except as noted ontheEmergencyWorker RegistrationCard (EMD-024), which might render me unfit tocarry out my emergency assignment.
(WAC118-04-120)
I willnotuse any liquors,narcotics or controlledsubstance nor will Ihaveinmy possession anyconcealed weaponwhile engaged in emergency workeractivities unless authorized by the Incident Commander.
(WAC118-04-200)
I havereported onmy backgroundcheck formall crimesof which I have been convicted. Iunderstandthat thefinal determinationforissuance of Washington StateEmergency WorkerIdentification cardwill be at thediscretion of the Tacoma-PierceCounty Health Department Director of HealthastheDirector ofEmergency Management designee and/or theWashingtonStatePatrolordesignee. I also understand that theDirectorof Health astheDirectorof Emergency Management designeeortheWashington State Patrolor designee may withdraw orsuspend my EmergencyWorkerCard and IdentificationNumber at anytime andat their discretion.(WAC118-04-080)
Iunderstand that Iwill haveto successfullycomplete the IS-700 NIMS course.I will alsoprovideacopy ofmy FEMAIS-700 NIMS certificationto theTacoma-Pierce County HealthDepartment. NoWashingtonStateEmergencyWorker Identification Card will be issued until I complete this process.
Ihereby give permissionfortheTacoma-PierceCounty HealthDepartment and/orthe WashingtonStatePatrol toconduct acriminal historybackgroundcheckand also obtain anabstractofmy drivingrecord.
Signed_Date//
(Applicant)
Approved on this
dayof , 2008
(DirectorofHealth)
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