Town of Smithfield

Emergency Management Agency

Volunteer Entrance Survey Form

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Thank you for your interest in volunteering for the
Town of Smithfield Emergency Management Agency.

Please complete and submit this application.
You will be contacted by the Director of Emergency Management
to schedule an interview.

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Please indicate the team which you are interested in joining:

Community Emergency Response Team (CERT)   Search and Rescue

Please provide the following contact information:

First Name: M I: Last Name:

Street Address:

City: , State: Zip Code:

Home Phone: E-mail:

Please provide any additional information about yourself:

Please be aware:
All volunteers are required to sign a release
and undergo a criminal and driving background review.

Releases are provided at your interview.

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