Bell County Reservist Applicant Survey

First Name:

Last Name:

Street Address:

City:                                Zip Code:


Day Phone:                    Evening Phone

Email Address


TX Drivers License #

Current Employer:

In order to be in the Bell County Reserve Program you must be able to pass a background check.
If you have ever been convicted of a felony your application cannot be accepted.

I have never been convicted of a felony
I have a special circumstance which I would like to discuss in person.

The Bell County Reserve Program is designed around the National Incident Management Systems (NIMS)
A requirement for acceptance is  the completion of NIMS training ICS-700
 If you have not completed this training you may continue the application process however if accepted your
acceptance will be contingent upon you completing this NIMS training within 30 days of acceptance of your application.

Have you completed the NIMS training:

List your most recent emergency management courses completed with dates if any:

List other emergency response organizations you belong to:

Are you a US Citizen or Legal Immigrant:

Are you now, or have you ever been employed by Bell County?

Which statement best describes you:

Tell us a little about yourself:. Include any information that you believe would be useful as an emergency
management volunteer.

If you are prior Military please tell us about your service. Service Period, Rank, MOS, special training, etc..

Why do you want to be a member of the Bell County Reserve Program?

How did you hear about the Bell County Reserve Program?

What skills do you have:

Skills Microsoft Word
Microsoft Excel
Ham Radio Technician
CPR/AED Certified
Ham Radio General or Higher
EMT or Paramedic
Certified Police Officer
Certified Fire Fighter


During an emergency requiring the activation of the Bell County Reservist I will be available:

Day (8am - 5pm)  Evenings   Any
Day (8am - 5pm)  Evenings   Any
Day (8am - 5pm)  Evenings   Any
Day (8am - 5pm)  Evenings   Any
Day (8am - 5pm)  Evenings   Any
Day (8am - 5pm)  Evenings   Any
Day (8am - 5pm)  Evenings   Any
Any Time Any Day
Any Time Weekends Only
Any Time Weekdays Only

I certify that the information provided is accurate and truthful to the best of my knowledge: