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CEN ReadyWI Safety Security Officer Application
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* Indicates required question
Email
*
Your email
First Name:
Your answer
Middle Name
Your answer
Last Name:
Your answer
Date of Birth
MM
/
DD
/
YYYY
Address:
Your answer
Address 2:
Your answer
City:
Your answer
State:
Your answer
Zipcode:
Your answer
Phone/Cell:
Your answer
Phone/Other:
Your answer
Email/Non G-mail:
*
Your answer
Email/G-mail:
Your answer
Website:
Your answer
Current Employment Status:
*
Full Time
Part Time
Retired
Volunteer
Other:
Required
Church Referral: (Attach referral explaining why you are qualified and in good standing with references contact info Please email file to
gary.schultz@christianemergencynetwork.org
)
*
Yes I have sent the file
No I have not sent the file yet
Security Experience:
*
Credentials
Training
Security History
Other:
Required
Security Professional Associations:
*
FEMA
DHS
FBI
Police
Fire
EMS
PI
Armed Services
Other:
Required
Security Experience: (Please email file to
gary.schultz@christianemergencynetwork.org
)
*
Yes I have sent the file
No I have not sent the file yet
Security Referral: (Please email file to
gary.schultz@christianemergencynetwork.org
)
*
Yes I have sent the file
No I have not sent the file yet
Security Reach: (Your preferred training area)
*
National
State
City
Church
Other:
Required
InfraGard member: (
https://www.infragard.org/
) if yes, please provide infragard number on the Other line below. *
Yes
No
Other:
Clear selection
Lausanne Covenant Agreement: (
http://www.christianemergencynetwork.org/about/statement-of-faith
)
*
Yes
No
ReadyChristian: (
http://www.christianemergencynetwork.org/training-programs/readychristian
)
*
Yes
No
Other:
Safety Security Officer Training Introduction:(
https://www.christianemergencynetwork.org/kurt-jordan
)
*
yes
No
Required
Safety Security Officer Agreement: (
https://www.christianemergencynetwork.org/kurt-jordan
)
*
Yes
No
CEN Advisor:
*
Your answer
A copy of your responses will be emailed to the address you provided.
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