Fire Rescue

Application

Please complete your application by either downloading and filling out the PDF version here: CERT Application PDF, or by filling out and submitting your information through the form below.

Personal Data
Last Name
First Name
Date of Birth
Race
Gender
Height
Eye Color
Mailing Address
Home Telephone
Cellular Telephone
Work Telephone
Pager
Fax

Primary Email
Secondary Email
Emergency Notification
Contact Name
Contact Telephone
Contact Address
Special Training
First Aid Training
Date of last First Aid Training
First Aid Training Authorizing Agency
CPR Training
Date of last CPR Training Training
CPR Training Authorizing Agency
Other Training
Languages Spoken Other Than English
Do you have any physical or medical conditions that might affect your participation in any exercise used in the course?
CERT Session Date Preference

CERT training is offered by Alachua County Fire Rescue (ACFR) at no charge to public. You will be given ACFR CERT Standard Operating Guide (SOG) and will be issued equipment by Alachua County Fire Rescue for use during activation and ACFR CERT sanctioned training. I understand that any and all equipment issued to me is the property of Alachua County Fire Rescue and that I am expected to return it in good condition upon demand or if I chose to resign from the ACFR CERT program.

I understand that that I will receive a "Certificate of Completion" only upon attending all modules of the course. In additionYouI will only become eligible to become an active ACFR CERT upon completion of IS-100 Introduction to Incident Command System and IS-700 National Incident Management System (NIMS). I will have seven weeks during the course to obtain IS 100 and IS 700 certificates from FEMA (http://training.fema.gov/IS/crslist.asp?page=1) via the internet and provide a copy to the instructor.

Active CERTS are required to attend regular scheduled CERT drills and or AFCR sanctioned CERT drills, training, conference etc. to maintain their Active CERT Status.

I understand that by completing this course I will learn certain basic skills that are intended to help me render assistance to others only when I deem it safe and necessary for me to do so. I am under no obligation, by virtue of having received this training, to render aid or become involved in any activities that would make me feel uncomfortable or have the potential to cause me physical or emotional injury.

By submitting this form, I affirm that I understand that when acting as a CERT volunteer I may only:

  1. Act within the scope of my official duties, and
  2. 2. Act in furtherance of a public purpose.

I understand that deviation from the above may result in personal liability.