P.O. Box 1328

Edmonds, WA  98020

Phone: 425.776.0414

Fax: 425.776.0467

 

Application

If you are interested in being considered by IMST, Inc. for use as an ICS resource please complete the following application and submit it to IMST, Inc. IMST, Inc. does not guarantee that we will accept your application or utilize you in an ICS position. All fields must be completed for consideration. Please denote N/A where applicable.

If you would rather you can send us a hardcopy of this form, just print this page to your printer after you fill it out  and mail it to us at the above address.

Name:

Address:

City:

    State:     Zip:

Home Phone:

                  Cell Phone:

Work Phone:

                      Fax:

Email:

 

 

Positions you are qualified for:

Last date you filled
this position

Are You Currently Red-Carded
 For This Position?

Yes

 No

Yes

 No

Yes

 No

Yes

 No

Special Skills:
 
i.e. photographer, electronics, computer, etc.
 

Any Physical Limitations:
 

Other
 Restrictions:
i.e. only work on West Coast; only work 10 days, etc.

  

 Emergency Contact:
Name:

Phone:

Relationship: Secondary

Phone:

   Can your personal vehicle be used?:      Yes     No 
   Can your personal cell phone be used?   Yes     No 

Any Other Information We Should Know?: