Application Forms 
Revised Feb. 200

HHS/ASPR/OPEO Human Resources Department

Application Process for DMAT Team Membership

INITIAL APPLICATION PACKET 
(the following documents have to be completed and mailed to our office.  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

________________________________________________________

The following forms are for the applicant to use as reference when the processes outlined are initiated.

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

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

e-QIP
(Applicant completes and keeps these forms for reference when the online process begins)

• 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

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