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2. First Name
3. Last Name
5. Phone Number
7. Email Address
9. Please provide a short description as to why you are interested in this opportunity
11. Please list any skills that you have that may help as a C.E.R.T. team member.
13. Are you willing to willing to participate in 20 hours of prerequisite training to be a certified CERT member.

    1. Yes
15. Are you willing to submit to a CORI background check?

    1. Yes
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17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

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