City of New
Orleans
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Office of Homeland Security
and Emergency Preparedness
Auxiliary Division
Basic Membership Application
A: General Information
1.
Full Name: _______________________________________
2.
Full Address: _____________________________________
3.
Sex M/F______
4.
Birth Date: ____________________
5.
Phone Number: _________________
6.Email
Address___________________
B:
Experience
List
any experience you have that may be helpful to our organization.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
C: Division
Place an x next to the division you wish to join.
____ Communication
____ Rescue
____ Operations
____ Planning
Please note that all Divisions require you to be CERT certified. We will provide the required CERT Training.
D: Background
Answer Yes or No to each question.
____ 1: Have you ever be convicted of a Felony?
____ 2: Do you have a valid driver license?
_____3: Do you use any Illegal drugs?
_____4: Are you employed with the City of
_____ 5: Are you a legal
_____6: Are you employed?
_____ 7: Can you stay in the City during a Hurricane to assist the
O.E.P?
If
you answer Yes to question 1 and/or 3 explain below.
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
E: Neighborhood Cert Teams
____ I am not interested in joining the volunteer corps but would like information on how I can start a CERT team in my neighborhood.
____ I would like to join the volunteer corps or would like information on how I can start a CERT team in my neighborhood.
After
we receive your application you will be contacted to schedule an interview.
Please email the completed form via email attachment to nooep@cityofno.com