Community Emergency Response Team Training Application

The City of Hoboken invites members of the community to join its 100-strong and growing Community Emergency Response Team (CERT). Free classes are offered by State-certified trainers.

Hoboken’s CERT volunteers have been recognized as “Community Preparedness Heroes” by FEMA, and CERT Coordinator Lou Casciano was honored as a Community Preparedness and Resilience “Champion of Change” by the White House.

CERT training promotes a partnering effort between emergency services and the people that they serve. The goal is for emergency personnel to train members of neighborhoods, community organizations, or workplaces in basic response skills. CERT members are then integrated into the emergency response capability for their area. If a disastrous event overwhelms or delays the community’s professional response, CERT members can assist others by applying the basic response and organizational skills that they learned during training. These skills can help save and sustain lives following a disaster until help arrives. CERT skills also apply to daily emergencies. If interested in joining CERT, please complete and submit this application.

Participation in CERT requires the successful completion of a training course on a range of subject matter specific to emergency response and disaster relief.

Home Phone

Mobile Phone

Work Phone

Employer Name (if applicable)

I am 18 years or older

Yes

Have you ever been arrested?

Yes Yes No

This program does include physical activity. If you require any special accommodations to participate in the program, please explain:

Emergency Contact Phone

How did you learn about CERT training?

Why do you want to attend CERT Training?

Check off all the areas in which you have past experience

CERT Program

Fire safety and fire suppression

Hazardous materials safety

Emergency medical triage & treatment

Search & rescue techniques and markings

Incident Command System (ICS) operations

Disaster psychology

Exercise controller

Check off all the options for which you wish to be considered

Lead Instructor

Co-Instructor: Emergency Preparedness

Co-Instructor: Fire Safety/Hazardous Materials

Co-Instructor: Emergency Medical Operations

Co-Instructor: Exercise Safety Officer

Co-Instructor: Light Search and Rescue

Co-Instructor: Disaster Psychology

I understand a background check will be conducted on all applicants. I authorize a background check on me based on this application. I give permission for any still photography or video footage in which I may appear to be used for whatever purpose deemed appropriate. I do this voluntarily and with the understanding there is no remuneration. In addition, I release any involved agencies and jurisdictions from any liability related to this training. All information on the above application is true.

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.