State of Montana Type 3 All-Hazards Incident Management Team Credential Application Form

Transcription

1 This form and documentation is being submitted to be reviewed by the SQRC for (check only one): Full qualification Trainee qualification Providing additional documentation as requested Re-Credentialing The pathway to qualification being pursued is (check only one): (Refer to Pathways to Qualification in the State of Montana Type 3 All-Hazard Incident Management Team Qualifications System Guide) 1 ICS Type 3 Position Qualification Criteria 2 Historical Recognition NWCG ICS qualification Local ICS qualification Other ICS qualification system, please specify 3 Recognition of Prior Learning POSITIONS FOR WHICH YOU ARE SEEKING STATE CREDENTIALING NAME: AGENCY: IMT NAME: ADDRESS, CITY, STATE, ZIP: PHONE NUMBER: CELL NUMBER: ADDRESS: RANK AND/OR WORKING TITLE: Applicant s Signature Date I verify that the applicant meets all the certification and credentialing requirements, as stated in the Montana All- Hazard Incident Management Assistance Team Qualification System Guide dated May, Verifying Official Signature Title Date Comments: 1

2 Experience Record Record of Experience for the Position (Last 5 years) Incident Name Location Date Position Incident Kind # of Days 2

3 Training Record Record of Training Courses for the Position Training Course Location Dates 3

4 Application Instructions Requirements all pathways to credentialing. All applicants MUST meet current requirements, depending on pathway being used to pursue qualification, as identified in the Montana Type 3 All-Hazard Incident Management Team Qualifications System Guide. Verifying official MUST verify all records and requirements are true and correct, utilizing the Application Form. (The verifying official is your team coordinator or Incident Commander, your local/tribal DES Coordinator, your agency/department head.) All applicants MUST record pertinent training courses for the applied for position, utilizing the Training Record. All applicants MUST record pertinent experience that demonstrates the knowledge, skills and abilities for the applied position, utilizing the Experience Record. How to Apply Select one of the following pathways to credentialing. Follow the pathway s instructions. 1) ICS Type 3 Position Qualification Criteria Review the ICS Type 3 Position Qualification Criteria portion of the Montana Type 3 All-Hazard Incident Management Team Qualifications System Guide to assure that all criteria have been met. Complete the application listing all positions for which you are seeking a state credential. Sign the application form. Obtain the verifying official signature. The verifying official should also review the ICS Type 3 Position Qualification Criteria portion of the Montana Type 3 All-Hazard Incident Management Team Qualifications System Guide to assure that all criteria have been met. Verifying official MUST verify previous three (3) years of experience for the position for which the applicant is applying, utilizing the Experience Record. Completed Experience Record that demonstrates the knowledge, skills and abilities for the applied position. Completed Training Record with attached copies of required course completion certificates A copy of the relevant Position Task Book(s) completed Evaluator page (page 2). OR 1a) Trainee - ICS Type 3 Position Qualification Criteria Review the ICS Type 3 Position Qualification Criteria portion of the Montana Type 3 All-Hazard Incident Management Team Qualifications System Guide to assure that all criteria have been met. Complete the application listing all positions for which you are seeking a state trainee credential. Sign the application form. Obtain the verifying official signature. The verifying official should also review the ICS Type 3 Position Qualification Criteria portion of the Montana Type 3 All-Hazard Incident Management Team Qualifications System Guide to assure that all criteria have been met. Verifying official MUST verify previous three (3) years of experience for the position for which the applicant is applying, utilizing the Experience Record. 4

5 Application Instructions Completed Experience Record that demonstrates the knowledge, skills and abilities for the applied position. Completed Training Record with attached copies of required course completion certificates A copy of the relevant Position Task Book(s) initiated cover page (page 2). 2) Historical Recognition Review the Historical Recognition portion of the Montana Type 3 All-Hazard Incident Management Team Qualifications System Guide to assure that all criteria have been met. OR Complete the application listing all positions for which you are seeking a state credential. Sign the application form. Obtain the verifying official signature. The verifying official should also review the Historical Recognition portion of the Montana Type 3 All-Hazard Incident Management Team Qualifications System Guide to assure that all criteria have been met. Verifying official MUST verify previous three (3) years of experience for the position for which the applicant is applying, utilizing the Experience Record. Complete the Experience Record with experiences acting in the applied position(s). Complete the Training Record and attach copies of course completion certificates. Submit documentation that substantiates your training and experience for the desired positions. Examples may include, but may not be limited to, IAPs, ICS 214 from incident documentation packages, letters of reference, performance evaluations from incidents, position task books or equivalent, log books or other records of performance, course attendance records/certificates 3) Recognition of Prior Learning OR Review the Recognition of Prior Learning portion of the Montana Type 3 All-Hazard Incident Management Team Qualifications System Guide to assure that all criteria have been met. Complete the application listing all positions for which you are seeking a state credential. Sign the application form. Obtain the verifying official signature. The verifying official should also review the Recognition of Prior Learning portion of the Montana Type 3 All-Hazard Incident Management Team Qualifications System Guide to assure that all criteria have been met. Complete the RPL self-assessment. Provide documentation showing that you have performed and successfully completed the relevant competencies of the position(s) applied for. Examples include training certificates, letters, photographs, and other documentation you can provide to support that you have met the competencies for the desired position(s). Participate in an evaluation and defense of your application and self-assessment with the RPL Peer Review Group. 5

6 Application Instructions Applicants should submit completed applications to their sponsoring AHIMT Incident Commander/ Team Coordinator/DES Coordinator/Agency/Department Head. The IC/Team Leader/DES Coordinator/Agency/Department Head will forward the completed credentialing package to the State AHIMT Coordinator. Submit completed application to: HARDCOPY Paul Fieldhouse Dept. of Natural Resources and Conservation, Forestry Division, Fire & Aviation Mgmt Bureau 2705 Spurgin Road, Missoula, MT FAX (Address to Paul Fieldhouse) 6