2024 Crawford Erie County Wildland Fire Crew Interest Form

By completing this form, you are expressing your intent to become involved as a member of the Crawford Erie County Wildland Fire Crew which operates under the direction of Forest Fire Wardens in Crawford and Erie Counties in Northwestern Pennsylvania. Completion of this interest form will notify the wardens that you are interested in becoming an active and contributing part of the crew.

Incomplete interest forms will not be considered.

Question Title

* 1. Last Name

Question Title

* 2. First Name

Question Title

* 3. Middle initial

Question Title

* 4. Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 5. Birthdate

Please provide your birthdate

Date

Question Title

* 6. How did you hear about Crawford Erie Counties Wildland Fire Crew?

Google or other search

CEC Website

Referred (please indicate who referred you in remarks below)

Other (Please explain below in remarks)

Remarks:

Question Title

* 7. Fire Department or Agency Affiliation

Question Title

* 8. PA Driver License Number

Question Title

* 9. PA EMS Level of Training

First Responder

EMT-Basic

EMT-Advanced

EMT- Paramedic

Healthcare Professional

List PA EMS Certification Number and expiration date:

Question Title

* 10. Please check all courses completed and for which you have certificates. Upon acceptance into the crew, you will need to provide copies of all certificates, licenses, etc.

IS 100b (ICS100) - Introduction to the Incident Command System

IS-200b (ICS200) - Single Resources and Initial Action Incidents

IS-700 (NIMS) -National Incident Management System, an Introduction

S-130 - Firefighter Training

S-130 F - Firefighter Training Field Day

S-190 - Introduction to Wildland Fire Behavior

S-200 - Initial Attack Incident Commander

S-211 Portable Pumps and Water Use

S-212 - Wildland Fire Chainsaws

S-215 - Fire Operations in the Wildland/Urban Interface

S-219 - Firing Operations

S-230 Crew Boss (Single Resource)

S-231 - Engine Boss (Single Resource)

S-270 Basic Air Operations

FI- 110 Wildland Fire Observations & Origin Scene Protection for First Responders

L - 180 - Human Factors in the Wildland Fire Service

L-280 - Follwership to Leadership

RT-130 - Wildland Fire Safety Training Annual Refresher

Other (please specify relevant training)

Question Title

* 11. Emergency Services or Employer Reference - Required

Name

Agency/Company/Department

Email Address

Phone Number

Question Title

* 12. Additional Reference - Required

Name

Agency/Company/Department

Email Address

Phone Number

Question Title

* 13. Emergency contact 1

Name

Relationship

Phone Number

Question Title

* 14. Emergency contact 2

Name

Relationship

Phone Number