HazMat Badge – Application Form - State Guard Association of the United States

HazMat Badge – Application Form

HazMat Badge – Application Form

SGAUS membership required. Incomplete applications will not be processed.

Date

Name

Name

First Name

First Name

Last Name

Last Name

Middle Initial

Personal Email

IE: joe.snuffy@gmail.com

Official Email

IE: joe.snuffy@army.mil | joe.snuffy@zulustateguard.gov

Rank

Spelled out – IE: Staff Sergeant (Do not include numbers, state, US, etc)

Service

Spelled out – IE: Air Force, Air National Guard, Zulu Defense Force. If not in a service: Leave Blank

Address

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Phone

I am a SGAUS Member

Yes

No

Military/Civilian Resume

Maximum file size: 5MB

PDF Only

Requested Badge Level

1. IS-100 Introduction to the Incident Command System 2. IS-200 ICS for Single Resources and Initial Action Incidents 3. IS-700 National Incident Management System 4. IS-800 National Response Framework 5. IS-75 Military Resources in Emergency Management 6. Introduction to Emergency Response to Terrorism Q0890 (USFA) 7. AWR 160 WMD/Terrorism Awareness for Emergency Responders (TEEX) or AWR- 358 Hazardous Materials Awareness Distance Learning (CDP) 8. Certified First Responder, or Basic CPR and First Aid Training 9. HazMat Operator Course see Local Fire Academy

Certificate Upload – IS-100

Maximum file size: 5MB

Official Certification Certificate as issued from certification vendor

Certificate Upload – IS-200

Maximum file size: 5MB

Official Certification Certificate as issued from certification vendor

Certificate Upload – IS-700

Maximum file size: 5MB

Official Certification Certificate as issued from certification vendor

Certificate Upload – IS-800

Maximum file size: 5MB

Official Certification Certificate as issued from certification vendor

Certificate Upload – IS-75

Maximum file size: 5MB

Official Certification Certificate as issued from certification vendor. Must be a NASAR SARTEC III certificate and must be valid (non expired). No other certificate will be accepted.

Certificate Upload – Introduction to Emergency Response to Terrorism Q0890 (USFA)

Maximum file size: 5MB

Official Certification Certificate as issued from certification vendor

Certificate Upload – AWR 160 WMD/Terrorism Awareness for Emergency Responders (TEEX) or AWR- 358 Hazardous Materials Awareness Distance Learning (CDP)

Maximum file size: 5MB

Official Certification Certificate as issued from certification vendor

Certificate Upload – Certified First Responder, or Basic CPR and First Aid Training

Maximum file size: 5MB

Official Certification Certificate as issued from certification vendor. *See Description Under Resources.

Certificate Upload – HazMat Operator Course see Local Fire Academy

Maximum file size: 5MB

Official Certification Certificate as issued from certification vendor. *See Description Under Resources.

Blue Flash

Documentation proving HazMat activation required

Blue Flash – Documentation

Maximum file size: 5MB

Documentation proving HazMat activation

If you are human, leave this field blank.