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FLORIDA EMERGENCY PREPAREDNESS ASSOCIATION

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FLORIDA EMERGENCY PREPAREDNESS ASSOCIATION Powered By Docstoc
					       FLORIDA EMERGENCY PREPAREDNESS ASSOCIATION
                           AND THE
         FLORIDA DIVISION OF EMERGENCY MANAGEMENT



                INSTRUCTOR
           RECOGNITION APPLICATION




                                          Revised 8/18/2010

                     Florida Emergency Preparedness Association and the
                          Florida Division of Emergency Management
                                 Instructor Recognition Program
                   400 Capital Circle SE, ST 18-263, Tallahassee, Florida 32301
                                       Phone: (850) 906-0779
                                        Fax: (850) 893-1845
                                           www.fepa.org
                                      www.floridadisaster.org


Disclaimer: The Florida Emergency Preparedness Association (FEPA) and The Florida Division of
Emergency Management (FDEM) is not establishing standards governing the conduct of any
emergency management instructor, or establishing any set procedures for work performance. The
Instructor recognition program is designated to establish educational, training, and experience criteria
relevant to emergency management training in the state of Florida and to recognize that an individual
has met these criteria.
Welcome to the Florida Emergency Management Instructor Recognition application process
sponsored by the Florida Emergency Preparedness Association and the Florida Division of
Emergency Management. This application has been designed to recognize individuals who possess
the experience, knowledge, and skills to effectively teach, instruct, and/or facilitate a comprehensive
emergency management program. The recognition is not only to identify those interested emergency
management professionals, but also emergency management partners in the public, private, and
volunteer sectors who dedicate their time and efforts to the training in the field of emergency
management.




This application affords the applicant three different levels of recognition for which to qualify:

Master Instructor (Type I): Highest level of recognition for those persons who hold advanced
instructor certifications and for persons who hold certifications from other organizations that the
emergency management profession wants to recognize as Emergency Management (EM) Instructors
such as: Federal Emergency Management Agency (FEMA), fire, police, hazardous materials
(HAZMAT), Homeland Security, etc

General Instructor (Type II): An Instructor certified in one or more recognized areas of instruction.
To include Homeland Security Exercise and Evaluation Program (HSEEP), Basic and Professional
Development Series, HAZMAT, Radiological, Incident Command System (ICS), etc.

Apprentice Instructor (Type III): This level is designed to encourage instructor mentoring.
Subsequent courses will be scheduled to partner the Apprentice with a more experienced instructor.
The Apprentice Instructors must be monitored by others instructor(s) prior to being approved to teach
identified courses. FEPA and FDEM would provide an opportunity for the Training Committee to
require additional experience before awarding a higher recognition level.

This recognition program identifies the full-time professionals who have devoted a minimum of four
years to the emergency management profession, with two of those years being in the State of Florida.
Applicants for this recognition must be able to prove their eligibility by including documentation of
required training, professional contributions, experience, and time.

NOTE: The FEPA/FDEM Recognition process also provides a shorter set of criteria for those
applicants who have already attained their Teaching and/or Instructor Certificates in other related
Emergency Response fields. A listing of each requirement for recognition is listed in the checklist on
page 4 - 5 of this application. Please be sure to fill out the FEPA/FDEM Recognition Criteria for
the appropriate Instructor Type for which you are applying.

Keep in mind that while you are filling in this application, you are submitting a document for your
Instructor Recognition. The application that you submit to the Education and Training Committee
must be organized in a three-ring binger with tabs or dividers identifying each set of documents that
are required. Neatness counts. The Committee may return any application that is not submitted in
this manner.
The recognition application has been designed to be easy to follow. Preceding each section of
requirements will be an instructional page that will tell you what is expected in each section. Please
be sure to follow the directions. These directions will help you to avoid common mistakes that are
made during the application process.
If you should have any further questions, please feel free to contact any of the FEPA/FDEM
Education and Training Recognition Committee members, listed on the FEPA Web Site at
www.fepa.org (see Recognition Page under Programs). Applicants are encouraged to work with a
Training and Education Committee mentor before submitting an application package to ensure
consistency and accuracy.




Revised 8/2/2010                                   2
                                                       FEPA and FDEM
                                            Instructor Recognition Application



Type of Instructor Recognition Applying For (Please check one)

                 Florida Emergency Manager Master Instructor (Type I)
                 Florida Emergency Manager General Instructor (Type II)
                 Florida Emergency Manager Apprentice Instructor (Type III)


Name of Candidate:

Current Position/Title:

Organization:

Office Address:

City/State/Zip:

Office Phone/Fax/E-mail:

Home Address:
City/State/Zip:

Home Phone/Fax/E-mail:

I understand that recognition is subject to the approval by both FEPA and FDEM, and if granted, is current for a five-year period. I will
execute the necessary documents and supply further information as determined by the FEPA Education and Training Committee. I
understand that any false statement or misrepresentation I make in the course of these proceedings may result in the revocation of this
application.

I give permission for verification of any information contained in this application package.

Candidate’s Signature:                                                                         Date:


I wish to receive notices at my:    ___ Office ___ Home
If awarded recognition I will allow FEPA/FDEM to post my picture on it’s web site: ___ yes __ no

Be sure to submit completed applications to Alton Scott at lafayem@windstream.net




Revised 8/2/2010                                                     3
                                   FEPA/FDEM INSTRUCTOR RECOGNITION CRITERIA
Checklist is required to be completed when applying for recognition consideration.
       Criteria                     Master Instructor                       General Instructor                        Apprentice Instructor
                                        (Type I)                                (Type II)                                  (Type III)
Work History/             5 years Teaching experience or             3 years Teaching experience or          2 years Emergency Response
Experience                 equivalent;                                 equivalent;                            experience or equivalent.

                          Of which 2 years was attained in           Of which 2 years was attained in
                           Emergency Management;                       Emergency Management;

                                            AND                                       AND

                          Three (3) Florida exercises within five Two (2) Florida exercises within five
                           (5) years and/or actual disaster           (5) years and/or actual disaster
                           experience(s) within last ten (10)         experience(s) within last ten (10)
                           years.                                     years.
                                        OR
                          A Bachelors or Masters College
                           Degree in the Field of Occupation
                           Education or related Field will
                           substitute for this requirement.


References               Three (3)                                  Three (3)                                Three (3)
Education                High School diploma or GED                 High School diploma or GED              High School diploma or GED


Technical                List of technical training courses or      List of technical training courses or    List of technical training courses or
                          programs and who provided the               programs and who provided the             programs and who provided the
Training                  program                                     program                                   program




Revised 8/2/2010                                                        4
                  WORK HISTORY / EXPERIENCE SECTION INSTRUCTIONS
Requirements:
       Criteria                Master Instructor                    General Instructor            Apprentice Instructor
                                   (Type I)                             (Type II)                      (Type III)
Work History/            5 years EM experience or           3 years EM experience or           2 years EM experience or
Experience               equivalent;                        equivalent;                        equivalent;

                         Of which 2 years was attained      Of which 2 years was attained       Of which 1 year was attained
                         in Florida;                        in Florida;                        in Florida;
                                       AND                                 AND                              AND
                                                           
                         Total of Two (2) Florida           Total of Two (2) Florida           One (1) Florida exercise or
                         exercise(s) within two (2) years   exercise(s) within two (2) years   actual disaster experience
                         and/or actual disaster             and/or actual disaster             within last ten (10) years.
                         experience(s) within last ten      experience(s) within last ten
                         (10) years.                        (10) years.




Work History / Experience
I.      Work Experience must be Emergency Management related, responsible for or participate in all four
        phases of Emergency Management: planning, response, recovery and mitigation. Proof of
        Emergency Management related work and experience must be documented and included in the
        applicant’s submittal through one of the following:
        a.        Position Description.
        b.        Signed letter from Emergency Management Director from applicant’s jurisdiction including
                  dates of emergency management service.
        c.        Signed letter from supervisor of applicant stating emergency management as a primary
                  function of applicant’s position and dates of emergency management service.
        d.        Firefighters, law enforcement personnel, and other public safety-related personnel must show
                  emergency management related duties other than general response and training (i.e.,
                  response to emergency or disaster if dispatched, etc.). This can be done through any of the
                  above (a-c).

        e.        Military, DD-214 and proof of emergency response with documentation of job skills.

Disaster / Exercise Experience
I.      For Disaster Experience credit, applicant must document at least 24 hours of active involvement in the
        emergency or disaster event occurred within the last ten (10) years to be eligible for consideration.

II.     For Exercise Experience credit, applicant must have participated within the last two (2) years and/or disaster
        experience must have occurred within the last ten (10) years to be eligible for consideration.

III.    Attach documented proof of participation. This can include a letter from the emergency management director, a
        certificate with applicant’s name on it, a newspaper article, or other documentation showing participation in the
        exercise or disaster event.

IV.     Those individuals with the FEPA FPEM Certifications are presumed to have the required Emergency
        Management Experience, documentation must be provided.


Revised 8/2/2010                                                5
                           WORK HISTORY / EXPERIENCE
WORK HISTORY/EXPERIENCE #1
Period Covered:

Jurisdiction/Company/Organization:

Address:

City/State/Zip:

Office Phone:

Job Title:

Supervisor and contact information:

WORK HISTORY/EXPERIENCE #2
Period Covered:

Jurisdiction/Company/Organization:

Address:

City/State/Zip:

Office Phone:

Job Title:

Supervisor and contact information:

WORK HISTORY/EXPERIENCE #3
Period Covered:

Jurisdiction/Company/Organization:

Address:

City/State/Zip:

Office Phone:

Job Title:

Supervisor and contact information:




Revised 8/2/2010                       6
                           REFERENCE SECTION INSTRUCTIONS
Requirements:

        Criteria           Master Instructor             General Instructor           Apprentice Instructor
                               (Type I)                      (Type II)                     (Type III)

       References Three (3)                           Three (3)                 Three (3)



I.        The first reference must be your current supervisor

II.       Other reference sources who qualify are:

                  A past supervisor (within 7 years)
                  Local, state, or federal government officials, or department heads;
                  Emergency service organization officials (e.g., public private, military, tribal)
                  State or national emergency management association officers
                  Others (by request to and approval of the Certification Commission

III.      Reference sources who do not qualify are:

                  A subordinate
                  A former student
                  Friends, neighbors, or relatives

NOTE:         Candidates are encouraged to inform references that they have been listed and may
              receive a phone call from a member of the Education and Training Committee, at their
              discretion, to verify information.




Revised 8/2/2010                                         7
                                REFERENCES
REFERENCE #1 (Current Supervisor)

Name:

Title:

Organization:

Address:

City/State/Zip:

Phone/Fax/E-mail:

REFERENCE #2

Name:

Title:

Organization:

Address:

City/State/Zip:

Phone/Fax/E-mail:

REFERENCE #3

Name:

Title:

Organization:

Address:

City/State/Zip:

Phone/Fax/E-mail:




                    EDUCATION SECTION INSTRUCTIONS
Revised 8/2/2010                    8
Requirements:
      Criteria        Master Instructor            General Instructor         Apprentice Instructor
                           (Type I)                     (Type II)                   (Type III)
 Education       High School diploma or GED   High School diploma or GED   High School diploma or GED

I.        All candidates are required to have a minimum of a high school diploma or GED.

II.       Candidates must provide a copy of their high school or college diploma in order to
          satisfy this requirement. If the name has changed due to change in marital status or other
          reason, a brief explanation should be attached.

III.      All submitted Technical and Trade Courses must be documented.




Revised 8/2/2010                                   9
                                            EDUCATION
REMINDER: A copy of the diploma must be attached, if you have a college degree you do not need to list the
high school diploma.
HIGH SCHOOL DIPLOMA OR GED (must attach copy)
Institution:

Address:

City/State/Zip:

Office Phone / FAX:



Technical or Trade Schools, and Training Programs (must attach copy)
Institution:

Type of Program/Certificate:

Course included:

Address:

City/State/Zip: Mo

Office Phone / FAX:




COLLEGE DIPLOMA (must attach copy)
Institution:

Type of Degree:

Major/Minor:

Address:

City/State/Zip: Mo

Office Phone / FAX:




Revised 8/2/2010                                    10
1.     TEACHING OR INSTRUCTING
       Teaching or instructing experience.

                                      (Duplicate form as necessary)
       a.      To satisfy this requirement, a candidate must attach verification of teaching or instructing.




Course Title (Course # if applicable):

Date of activity:


Location of activity:


Sponsoring organization:


Description and length of Training program:




Name phone number who can verify teaching or instruction commitment:




Revised 8/2/2010                                       11
                        TRAINING SECTION INSTRUCTIONS
Requirements:


I.     Training course documentation (certificates, training submission forms, etc.) should be put
       into the same order that it is listed on the Training Summary Form.
II.    Emergency Management Training includes any local, state, or federal sponsored
       emergency management training course or other emergency management-related training
       course (e.g., Military, Federal/State/Local Government, American Red Cross, American Heart
       Association, Civil Air Patrol, etc.)
III.   General Management Training includes training courses that are general in nature to
       management practices and principles, such as communications, business administration,
       marketing, human relations, public relations, volunteer development, grants management, etc.
       (e.g., Career-Track, Florida Institute of Government, etc.).
IV.    A maximum of 25 hours in any one topic or subject will be accepted per documented training
       course.
V.     One college credit equals 15 hours and one CEU equals 10 hours.
VI.   A maximum of 10 hours will be awarded for each FEMA Independent Study Course
submitted.




Revised 8/2/2010                                  12
2. TRAINING COURSE COMPLETIONS

       Duplicate Form as Necessary


                                                           Course #
                      TITLE OF TRAINING COURSE                if
                                                          applicable




                                                 TOTALS


  3. TRAINING RECEIVED IN EMERGENCY MANAGEMENT
Revised 8/2/2010                        13
        SUBMISSION FORM
                                     (Attach Training Certificate)
                                  (Duplicate this form as necessary)




    Training Title:

    Course Number (if applicable):

    Training Source:

    Training Date:

    Training Length (in hours):


    Training content summary (You may instead attach a copy of the catalog or other printed
    description of the course or a syllabus):



    Describe practical applications of training opportunities as you have utilized those learning
    principles:




Revised 8/2/2010                                  14
                                          

4.     DISASTER EXPERIENCE
       Evidence of significant disaster and recovery management experience – delineates that candidate was actively
       involved in the response or recovery phase of an actual disaster.

       a.   To satisfy this requirement, documentation must include the level of active involvement and delineate a
            minimum of 24 hours of disaster involvement. For Exercise Experience credit, applicant must have
            participated within the last two (2) years and/or disaster experience must have occurred within the last ten
            (10) years to be eligible for consideration.


Type of disaster event:

Date/duration of experience:

Location of experience:

Describe the magnitude and severity on the community of the disaster:




Describe your role during the event:




Describe any lessons learned from your participation in this event:




Name and phone number who can verify service:




Revised 8/2/2010                                          15
5.     EXERCISE EXPERIENCE
       Participation in a disaster exercise – either full scale, functional, or tabletop must be documented.

       a.    Experiential credit will be offered for those with field experiences. For Exercise Experience credit, applicant
             must have participated within the last two (2) years and/or disaster experience must have occurred within
             the last ten (10) years to be eligible for consideration.



Type of exercise:



Briefly describe the objectives of the exercise:



Date and location of the exercise:




Describe the exercise scenario:




Describe your role prior to, during, and after the exercise:




Describe the lessons you learned from the exercise:



Name and phone number who can verify service:




Revised 8/2/2010                                            16
6.     LEADERSHIP AND PARTICIPATION
       State, regional, or local committee work resulting in a significant positive impact on the Emergency Management
       Community.

       a. Credit will be offered for those with experiences in professional organizations.




Time frame/length of organizational service:



Committee/task force title:




Sponsoring organizations (be specific):




Description of charge/assignment:




Description of your role/contribution:




Description of product/contribution to the emergency management field:




Name and phone number who can verify service:




Revised 8/2/2010                                            17

				
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