Application Forms 
Revised Feb. 200

HHS/ASPR/OPEO Human Resources Department
Revised 9/2009

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

Application Process for DMAT Team Membership (A Two 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*  (see below)

7. 1199-A Direct Deposit Form Tape a voided check over section 3 of the form and there is no need to take the form to your local bank for verification.

8. Declaration of Federal Employment (OF306)

9. Fingerprint Forms - we will supply the following forms when you get your finger prints done. They are to be turned in simultaneously with the application packet, unless applicant goes to the Regional Office (information available from Administrative Officer), then copies of the forms can accompany the application packet along with the Regional Office appointment date that the applicant attended the fingerprinting session. Necessary forms include:

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

• Attachment B - Request for Background Investigation Form

• Attachment C - e-QIP Initiation Request Form

• Two completed finger print cards 

     eQIP / Security Process Forms to obtain Federal ID:  Please review these forms - you will be required to complete them ONLINE after you've completed the finger print/photo process for your ID and you've been officially approved.  Before your ID is issued to you - you will have to complete the EQIP process online - consisting of the following forms. If you want to print and complete them ahead of time -that will save you time online.  DO NOT send the following forms with the application packet - keep them for reference when you get the email regarding the eQIP process.

• SF 85P - Questionnaire for Public Trust Position Instructions 

• SF85 P Form

• OF 306 - Declaration for Federal Employment

• HHS Credit Release Form

*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 1-8 as noted above) to:

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

Blackberry 251-300-0859
Email dkeasler@al3dmat.com

________________________________________________________

PHASE II:  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.