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#24-005476-0020
Supplemental Questionnaire

Last Name
First Name

 

***Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.***
1.

Do you have 10 years of progressive experience in the delivery of emergency services (fire and/or haz-mat) or environmental response with at least 5 years of related professional supervisory experience? If yes, please explain your experience. If no, please write "N/A".

2.

Do you possess the following qualifications, as certified through Pro Board or IFSAC:
 

Hazardous Materials Technician OR Hazardous Materials/WMD Technician
Yes No
 

Incident Safety Officer
Yes No
 

Health & Safety Officer
Yes No
 

Incident Safety Officer - Hazardous Materials Operations
Yes No
 

Fire & Emergency Services Instructor III
Yes No

3.

Have you successfully completed the following National Incident Management System Courses?
 

ICS 100, 200, 300, 400, 700 & 800
Yes No
4.

Have you successfully completed an emergency Vehicle Operator's Course (EVOC)?
Yes No
5.

Do you have demonstrated knowledge or understanding of Continuity of Operations Planning?
Yes No
6.

Do you have Fire Officer III or IV certification from Pro Board or IFSAC?
Yes No
7.

Do you have knowledge or an understanding of Emergency Operations Center Functions?
Yes No
8.

Do you have demonstrated knowledge or understanding of the Radiological Emergency Preparedness Program?
Yes No
9.

Do you have knowledge or an understanding of the roles and responsibilities of a Public Information Officer (PIO) and/or Joint Information Center (JIC)?
Yes No
10.

Do you have knowledge/understanding of 'all Hazards Planning'?
Yes No

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