Tuscaloosa County CERT Refresher Course

Please complete the application below. If you are considering joining the newly formed Tuscaloosa County CERT Team, please complete, print and return your certified background check to Tuscaloosa County EMA before January 18, 2023.

**MUST PROVIDE CERT CERTIFICATE OF TRAINING**

Name*

First NameLast Name

Preferred Name*

Birth Date*

E-mail*

example@example.com

Cell Phone Number*

Area CodePhone Number

Home Phone Number*

Area CodePhone Number

Work Phone Number*

Area CodePhone Number

Place of Employment*

Are you a volunteer firefighter?*

If you answered yes, which department?

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Municipality/Town/Area of Residence*

Preferred Method of Contact*

Emergency Contact:

Relation:

Phone:

Allergy/ Medications:

Physical/ Mental Limitations:

If you were to be placed on a CERT team which area(s) would you feel the most comfortable or have skills in?

If you selected "Bi-lingual" above, please specify which languages:

If you selected "Amateur (Ham) Radio Operation" above, please provide your Ham Radio ID:

Comments

A certified background check is required to be a on a CERT team. Please complete the form below. You may email to ema@tuscco.com, mail to Tuscaloosa County CERT, 7400 Richard M. Pierce Pkwy, Northport, AL 35473 or upload at the bottom of this page before January 18, 2023.

File Upload for CERT Certificate and Background Check

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CERT Refresher Course

In Case Of Emergency