COLORADO EMERGENCY MANAGEMENT ASSOCIATION (CEMA) CERTIFICATION APPLICATION

Transcription

1 COLORADO EMERGENCY MANAGEMENT ASSOCIATION (CEMA) CERTIFICATION APPLICATION Revised 03/01/2013 Colorado Emergency Management Association Certification Program Disclaimer: The Colorado Emergency Management Association (CEMA) is not establishing standards governing the conduct of any emergency managers, or establishing any set procedures for work performance. The certification program is designated to establish educational, training, and experience criteria relevant to emergency management in the state of Colorado and to certify that an individual has met these criteria.

2 Welcome to the Colorado Emergency Manager Certification application process sponsored by the Colorado Emergency Management Association. This application has been designed to recognize individuals who possess the experience, knowledge, and skills to effectively manage a comprehensive emergency management program. The certification is not only to recognize emergency managers, but also emergency management partners in the public, private, and volunteer sectors who dedicate their time and efforts to the field of emergency management. This application affords the applicant three different levels of certification for which to qualify: Silver Level (CO-AEM): This certification recognizes those professionals who dedicate all, or a majority of their work, to emergency management, but may not possess the professional contributions, time, experience, or training requirements needed to get the professional certification. For many, this certification may act as a stepping-stone as one works toward the CO-CEM designation. Gold Level (CO-CEM): This certification recognizes the full-time professionals who have devoted a minimum of four years to the emergency management profession, with two of those years being in the State of Colorado. Applicants for this certification must be able to prove their eligibility for this certification by including documentation of required training, professional contributions, experience, and time. NOTE: The Colorado Certification process also provides a shorter set of criteria for those applicants who have already attained their Certified Emergency Manager (CEM) certification. A listing of each requirement for each certification is listed in the checklist on page 3-4 of this application. Please be sure to fill out the Colorado Certification Criteria for the appropriate certification for which you are applying. Keep in mind that while you are filling in this application, you are submitting a document for your professional certification. The application that you submit to the Committee must be organized in a three-ring binger with tabs or dividers identifying each set of documents that are required. Neatness counts. The Committee will return any application that is not submitted in this manner. The certification application has been designed to be easy to follow. Preceding each section of requirements will be an instructional page that will tell you what is expected in each section. Please be sure to follow the directions. These directions will help you to avoid common mistakes that are made during the application process. If you should have any further questions, please feel free to contact the CEMA Certification Co-Chairs, listed on the CEMA Web Site at (see Certification Page under Programs). Applicants are encouraged to work with a certification mentor before submitting an application package to ensure consistency and accuracy. 2

3 Be sure to: Refer to Certification Requirements and Certification Committee Operating Guidelines for application standards Submit one (1) complete CEMA Certification Application in 3-ring binder: must include application form, all copies or certificates, and other proof of education, training, and professional contributions Submit one (1) electronic copy of your complete CEMA Certification Application: must include *.PDF Scans, *.JPG format, and any MS Office compatible formats Include proper application fee: $25 Application Fee (CEMA Members) OR $100 Application Fee (non-cema members) MAKE CHECKS PAYABLE TO: CEMA Mail complete application to: FEES ARE NON-REFUNDABLE CEMA Certification Committee c/o Cheryl R. Dalton, CO-AEM Routt County Office of Emergency Management 522 Lincoln Avenue, Second Floor P.O. Box Steamboat Springs, CO

4 ALL MATERIALS MUST BE TYPED (unless otherwise specified) Check here if application is for recertification and include proper fees above. All re-certifications will be bumped up to the Gold level. Applicant Information: Name: Home Address: City: State: Zip: Phone: Certification Level Applying for: Silver Gold If you have requested a Gold or Silver level certificate, and the committee determines that you do not qualify at that level, would you like the committee to contact you to discuss whether you wish to be certified at a lower lever? Yes No Letter of Achievement: If your certification is approved, would you like a letter of achievement to go to your supervisor and/or other person? Yes No If yes, please provide their name and mailing address below. Name: Organization/Department: Address: City: State: Zip: I understand that certification is subject to the CEMA Certification Committee approval, and if granted, is current for a fiveyear period. I will execute the necessary documents and supply further information as determined by the Committee. I understand that any false statement or misrepresentation I make in the course of these proceedings may result in the revocation of this application. I also understand that all trademarks associated with this certification will be upheld and I will not misuse the trademark in any way. I give permission for verification of any information contained in this application package. Applicant's Signature Date 4

5 Experience Information: Please use the Certification Guideline and list your most recent experience first. Employer Name: Address: City: State: Zip: Supervisor Name: Supervisor Phone: Supervisor Title: Employed from (Mo./Yr.) To (Mo./Yr.) Average Hours worked per week: Percentage of time spent on Emergency Mngt. Your Job Title: Your Duties Employer Name: Address: City: State: Zip: Supervisor Name: Supervisor Phone: Supervisor Title: Employed from (Mo./Yr.) To (Mo./Yr.) Average Hours worked per week: Percentage of time spent on Emergency Mngt. Your Job Title: Your Duties Employer Name: Address: City: State: Zip: Supervisor Name: Supervisor Phone: Supervisor Title: Employed from (Mo./Yr.) To (Mo./Yr.) Average Hours worked per week: Percentage of time spent on Emergency Mngt. Your Job Title: Your Duties (Add additional experience below) 5

6 Emergency Management Training Classes: Please use the Certification Guideline and copies of documentation must be in the order listed below. Class Code/Name Sponsoring Agency Class Contact Name Contact Phone Description of Class Copy of Hours Certificate Professional Development Series Certificate- (Course Listings below) 1. Principles of Emergency Management 2. Exercise Design 3. Emergency Planning 4. Effective Communications 5. Developing Volunteer Resources 6. Decision Making and Problem Solving 7. Leadership and Influence Other Course Requirements 8. Emergency Program Manager: Orientation to the Position Additional Course Requirements: Please use the Certification Guideline and copies of documentation must be in the order listed below (Add additional training below) 6

7 Emergency Management Activities: Please use the Certification Guideline and copies of documentation must be in the order listed below Activity Sponsoring Agency Dates Contact Person Contact Phone Description of Activity Role Played Documentation Attached (Add additional activities below) 7

8 Education Information: Name of School or Institution: Address City State Zip Dates of Attendance: Full Time Part Time Degree/Diploma Received: Yes No if yes, type: Major: If no, how many hours completed? Qtr Hours Semester Hours Copy of transcript or degree attached Name of School or Institution: Address City State Zip Dates of Attendance: Full Time Part Time Degree/Diploma Received: Yes No if yes, type: Major: If no, how many hours completed? Qtr Hours Semester Hours Copy of transcript or degree attached Name of School or Institution: Address City State Zip Dates of Attendance: Full Time Part Time Degree/Diploma Received: Yes No if yes, type: Major: If no, how many hours completed? Qtr Hours Semester Hours Copy of transcript or degree attached (Add additional education below) 8

9 Additional Experience Information: 9

10 Additional Emergency Management Training Classes: 10

11 Additional Emergency Management Activities: 11

12 Additional Education Information: 12