Application Forms 
Revised Feb. 200

HHS/ASPR/OPEO Human Resources Department

If you are interested in joining AL3 DMAT please contact either: Administrative Officer, Diane Keasler dkeasler@al3dmat.com or Team Commander, Randy Smith   prsmith@al3dmat.com

Application Process for DMAT Team Membership (A Three Phase process)

PHASE I:

INITIAL APPLICATION PACKET 
(the following documents have to be completed and mailed to our Administrative Officer -see address below)

1. OF-612 form

2. Provide a current resume with as much detail as to your duties, skills, talents, etc. as possible

3. NDMS Member Information Form

4. Copy of diploma and/or transcripts for medical personnel

5. Copy of medical licensure and credentials

6. Copy of ISC 100. 200, 700 & 800 Certificates*

7. Completed Credit Card Application

*Information regarding ICS classes.  They are offered FREE online at http://training.fema.gov/IS/NIMS.asp Each class will take approximately 1 hour to complete. At the end of each class there will be a quick review quiz.  At the completion of the class you will be directed to a page that will allow you to print a certificate.  Keep a copy for your records and place a copy of each certificate with your application packet.

Mail Initial Application Packet (items 1-7 as noted above) to:

Attn:  Diane Keasler
AL-3 DMAT Administrative Officer
5350 S. Scanlan Way Dr.
Satsuma, AL  36572

________________________________________________________

PHASE II:  The following forms are for the applicant to use as reference when the processes outlined are initiated.  These forms are not required to be submitted with the application.- 

FINGERPRINT FORMS
(Applicant reviews these forms and keeps them until the security process occurs)

• Attachment A - PSC-29 Personal Identity Verification (PIV) Request Form

• Attachment B - Request for Background Investigation Form

• Attachment C - e-QIP Initiation Request Form

After the applicant's finger prints and photo are submitted to NDMS Security the applicant will receive an email (usually within 2 weeks) to complete the following process (eQIP) online.  

e-QIP
(Applicant completes and keeps these forms for when the online process begins - they are for YOUR REFERENCE and will be beneficial to you when this phase of the process is initiated.)

• SF 85P - Questionnaire for Public Trust Position Instructions

• SF85 P Form

• OF 612 - Application for Federal Employment

• OF 306 - Declaration for Federal Employment

• HHS Credit Release Form

___________________________________________________________

PHASE III:  When all of the forms and processes above are completed you will receive a letter from NDMS Human Resources offering you a position on the AL3 Team.  This letter will contain information regarding the e-Induction process.

e-INDUCTION PACKET
(Applicant reviews these forms and keeps them for review until the actual process takes place)

• Appointment Affidavit Form

• 1199-A Direct Deposit Form

• W-4 Federal Tax Form

• Educational Data Update Form

• I-9 Employment Eligibility Verification Form

• SF-181 Ethnicity and Race Identification Form

• SF-256 Self-Identification of Handicap Form

• DHHS Record of Home Address Form

Final Process:   When the e-Induction process is completed - the team Administrative Officer is contacted by NDMS HR and given permission to swear in the applicant with the Oath of Office and the process is complete.