Salem NH Citizen Corps Volunteer Form IMPORTANT NOTICE The electronic version of this form is temporarily unavailable so that we can make the system more secure. Ignore the Captcha box above the submit button. Do not use he submit button. Print the page with the completed form and mail it to the indicated address or fax it to 603 893 4290.
If you are willing to be listed as a Salem, NH volunteer to assist in Citizen Corps activities related to emergency preparedness and disaster response, fill out the form below. You will be contacted by a member of the Salem Citizen Corps Council to confirm your volunteer status. You may submit the completed form by email with the Submit Form Button or print this page and mail it to:
Fire Department Headquarters, Attn: Citizen Corps Council152 Main StreetSalem NH 03079
Volunteer Form
(Bold fields are required)
Please enter a return email Address
First Name Middile Initial (John J)
Last Name (Doe Jr)
A ddress
Adderss 2
City State Zipcode
Home Phone (1115551212) Cell Phone
Work Phone Contact at Work? NoYes
Home Email
Work Email
Check Email More than once a dayDailyInfrequentlyJust call me!
Employer
Employer Address
Employer City Employer State Emp Zipcode
Job Title
Job Description
Please select your skills and volunteering preferences. Use the CTRL key and Left Mouse Button or Enter to select multiple items.
Primary Skills Medical - DoctorMedical - Physicians Assistant/Nurse PracticionerMedical - RN/LPNMedical - Nursing Assistant/Medical AssistantMedical - VeterinarianMedical - Home Health AideMedical - PharmacistMedical - Phamacy TechnicianMedical - Medical TecnicianMedical - DentistMedical - Dental TechnicianMedical - AdministrativeMedical - Other (Please Specify)Information Technology - Computer OperatorInformation Technology - Data EntryInformation Technology - Computer RepairInformation Technology - Network ManagementTrades - ElectricianTrades - MechanicTrades - PlumberTrades - CarpenterTrades - Excavator OperatorTrades - Crane OperatorTrades - General LaborTransportation - ChauffeurTrades - Bus DriverTransportation - Bus DriverTransportation - Commercial Drivers LicenseTransportation - Tractor Trailer LicenseTransportation - Motorcycle LicenseSupport - CustodianSupport - CookSupport - Security GuardSupport - Trainer Support - Materials Managemment/Supply ManagerSupport - Professonal Grandma
Primary Skills - Other
Secondary Skills CPRFirst AidOutdoor SkillsBoy Scout LeaderSearch and RescueMilitary TrainingProject Management
Secondary Skills - Other
Volunteer Preferences MedicalSupportOutdoor WorkCERTSearch and RescueEducationCommunity Outreach
Volunteer Preference - Other
Resources you have 4X4 Truck4x4 VehicleGPSPlow EquipmentConstruction Equipment - CraneConstruction Equipment - Earth Moving EquipmentOther - Please Specify
Resources - Other
Languages
This data is for the exclusive use of Salem Citizen Corps for Emergency Management Planning
When you submit this form, you will see a screen which displays the information you filled in. On some browsers you may see an unfamiliar character in many of these fields This is alright. We are working to correct this.
If you need to make changes, send an email to postmaster@salemnhcitizencorps.org, or redo the form. We will use the latest one you submit.