EMSTF Member Availability

SIMULATED DEPLOYMENT 2017 NJEMSTF MEMBER AVAILABILITY

Use this form to report your resource as available for deployment for SIMULATED DEPLOYMENT activities

* Indicates required field

Name *

First

Last

What if your PRIMARY NJEMSTF Module *

Cert Level *

Who is your host/sponsoring agency? *

If responding to a SPECIFIC ORDER REQUEST, enter Order Reference Number here. *

Email *

Phone Number *

Primary Position Requested *

Secondary Position Requested *

AVAILABILITY *

OP1: Friday 9/8 0800-1700 OP2: Satuday 9/9 0800-1700 OP3: Sunday 9/10 0800-1700 OP: Friday - Saturday 0800 - 0800 OP: Saturday - Sunday 0800 - 0800 OP: Friday 0800 - Sunday 1700

Members can do strictly Daytime Operations on each day.
Members can do a 24 hr deployment.
Members can stay from Friday morning until Sunday afternoon.

Are you available for the full deployment period? *

YES NO Only Portion

If you are deploying as part of staff on a NJEMSTF ASSET, please state what unit here *

Comment *

Emergency Contact Name *

First

Last

Emergency Contact Number *

By clicking SUBMIT below, you verify that you are placing your availability for the DEPLOYMENT period you listed; that you understand you will may be held or housed in a CAMP or Staging Area to be determined; you understand that while the work hours you request may be honored, there are times work hours are extended to meet operational needs; you verify that your sponsoring agency has given you permission to participate in this deployment; that no deployment is authorized until you receive direct Deployment Orders from NJEMSTF Planning; and that reimbursement availablilty has not been determined for this deployment.

Submit

SIMULATED DEPLOYMENT 2017 NJEMSTF MEMBER AVAILABILITY

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After Action Survey - NJ PAPAL DEPLOYMENT