CIMC Nomination Application

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Please complete the below form when you have been nominated by your host agency.

First Name

Last Name

Email Address

Cell Phone # (one that you will have with you at CIMC)

Who are you employed by?

State Agency

Federal Agency (FS, USFWS, NPS, BLM, BIA)

AD through State

AD through Federal Agency (FS, USFWS, NPS, BLM, BIA)

Fire Service

Other:

Clear selection

What is the name of your employer or sponsoring agency?

What are your current and valid IQS or IQCS Incident Command System qualifications?

What position are you applying to go through CIMC as?

Incident Commander (IC)

Liaison Officer (LOFR)

Public Information Officer (PIO)

Safety Officer (SOFR)

Operations Section Chief (OSC)

Plans Section Chief (PSC)

Finance Section Chief (FSC)

Logistics Section Chief (LSC)

Agency Administrator

Do you have a valid Complex or Type 1 taskbook for a Command & General Staff position?

Yes

Clear selection

How much of your task book is complete?

Empty/New Book

25% completed

50% completed

75% completed

90-100% completed

Clear selection

Have you had a CIM (Complex Incident Management) evaluation completed for a Complex Command or General Staff position?

Yes

Clear selection

What was the result of the CIM Evaluation?

Met all Objectives for Complex Evaluation

Did not meet all Objectives of Complex Evaluation

Did not get the opportunity to demonstrate the CIM Objectives during the evaluation period or incident

Clear selection

How many assignments have you had working on the taskbook(s) that you have open for a Complex or Type 1 Command or General Staff position?

1-2

3-5

Clear selection

Are you currently rostered on a Complex, Type 2, or Type I Incident Management Team?

Yes

Clear selection

What team are your rostered on?

Have you completed S-420 (Command and General Staff) or L-481 (Advanced Leadership for Command and General Staff)?

Yes

Clear selection

Have you completed the O-305 (Type 3 All-Hazards Incident Management Team) course?

Yes

Clear selection

Submit

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