Online Volunteer Application

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This page contains the Emergency Management online volunteer application for Douglas County, Kansas.

By Mail/In Person
Download the 'Emergency Management Volunteer Application' (PDF format) and bring or send it to Douglas County, Kansas Emergency Management Department at 111 East 11th Street, Unit 200, Lawrence, Kansas 66044.

Online
This form will allow you to submit a volunteer application online:

(* denotes required fields)

Online Volunteer Application
Contact Information
First Name	*
Middle Initial
Last Name	*
Address	*
City	*
State	- Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Other *
Zip Code	*
Email Address
Home Phone	*
Work Phone
Cell Phone
Pager
Do you have immediate availability to the internet?	Yes  No   *
In case of emergency, please contact:
Full Name	*
Address	*
City	*
State	- Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Other *
Zip Code	*
Phone Number	*
Employment History
Current employment status	Employed   Not Employed   Retired   Student   *
If employed, name and address of employer:
Full Name	*
Address	*
City	*
State	- Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Other *
Zip Code	*
Phone Number	*
Length of time at employment	*
Character References Please list two character references (DO NOT INCLUDE RELATIVES)
Reference 1
Full Name	*
Address	*
City	*
State	- Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Other *
Zip Code	*
Phone Number	*
Relationship	*
Reference 2
Full Name	*
Address	*
City	*
State	- Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Other *
Zip Code	*
Phone Number	*
Relationship	*
Education
Last year completed of school:
High School	6   7   8   9   10   11   12   GED   *
College	0   1   2   3   4   *
Graduate School	0   1   2   3   4   *
Name of High School Attended	*
Name of College Attended
Degrees or Special Courses of Training
Foreign Languages (i.e. speak, read, write)
Health (Answering "No" will not disqualify you from volunteering. This will only be used as a guide to help determine the way that you may best serve.)
Are you able to perform strenuous physical labor such as filling sandbags?	Yes   No   *
Are you able to perform strenuous physical labor such as lifting or carrying heavy objects?	Yes   No   *
Volunteerism
Areas of interest	Auxiliary Communications Team* CERT Storm Spotter
Briefly state your reasons for wanting to volunteer with the Douglas County Emergency Management Office:
*
Special Skills (If available, mail any certificates and/or supporting documents to: Emergency Management Dept., 111 East 11th Street, Unit 200, Lawrence, Kansas 66044)
List any languages that you speak, including sign language
List any medical training
List any communication training
List any firefighting training
List any other special skills or abilities
Availability
When are you available for volunteer work?
Number of hours per week
Day(s) available	Mon. Tue. Wed. Thu. Fri. Sat. Sun.*
Time(s) of day	Daytime Evening Weekdays Only Weekends Only*
About You
Our experience has been that most problems with the past can be adequately explained to Douglas County Emergency Management, but if unknown at the time of selection, and later found out, it may create a problem. Please explain potentially negative things in your background. A background check will be completed before approval.
Accept/Decline
I certify that the above information contained in this application is complete and true to the best of my knowledge. I understand that there may be specific qualifications for some volunteer positions and that it may be determined that I do not satisfactorily meet those qualifications. I understand that references will be contacted. Further, I certify that I am 18 years of age or older and a citizen of the United States of America . I understand that Douglas County Emergency Management is not obligated to assign me if, in Douglas County ’s professional judgment, it would not be in my best interest or the best interest of EM. Once accepted as a volunteer, I realize I may be released from my volunteer position at any time. I authorize Douglas County Emergency Management to conduct any investigations necessary to verify the information provided herein, and to conduct any other job related investigations or inquiries necessary to determine my fitness for the position of Douglas County Emergency Management Volunteer. I understand said investigation may cover the following: Educational background Neighborhood reputation References Employment history I understand that before I become an active volunteer, I must pass a drug screen and a background check.
Yes   No   *

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Volunteer Opportunities
For more information volunteer opportunities, please contact:

• Douglas County Emergency Management
• 111 East 11th Street, Unit 200
• Lawrence, Kansas 66044
• Phone: (785) 832-5259
• Fax: (785) 832-5101
• Email: smeggison@douglas-county.com