Create Volunteer Profile

Welcome to the Jefferson County Homeland Security and Emergency Management Community Event Registration & Volunteer Information System (CERVIS). Thank you for your desire to serve as part of the JCHSEM team. Please complete the information requested below to submit your application for review. We look forward to serving with you!

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Volunteer Full Name:*

Volunteer Last Name:*

Volunteer First Name:*

Volunteer Primary Phone:*

Volunteer E-mail:*

Confirm E-mail:*

Volunteer Alternate Phone:

Volunteer Address:*

Volunteer Address Line 2:

Volunteer City/Town:*

Volunteer State:*

Volunteer Zip Code:*

Emergency Contact Name:*

Emergency Contact Phone:*

Emergency Contact E-Mail Address:*

Emergency Contact Relationship:*

Please list your C.E.R.T. Kit Number:

Do you have any Limitation of Duties?*

Are you a County Employee?*

Volunteer Birth Date:*

Volunteer Gender:*

Upload Volunteer Profile Photo:

Choose Photo

(.jpg, .jpeg, .png, or .gif format only and less than 5MB in size.)

Volunteer Interests:

Jefferson County Homeland Security & Emergency Mgt
- Business Continuity Planning Training
- Community Emergency Response Team Trng
- Emergency Response Guidebook Training
- Partnership Development Committee
- Public Awareness Committee
- Risk Assessment Committee
- Stormspotter Training-Basic
- Volunteer Mobilization Center Training

Volunteer Skills:

Skills
Filing/Clerical/Data Entry
First Aid
CPR-Trained
Ham Radio Operator

Volunteer Availability:

No Items Available For Selection