MRC-CERT Application

Medical Reserve Corps/ CERT App

Personal Information


Employment Information


Emergency Contact



Please indicate the days and times you are usually available to volunteer. This would be for routine volunteer opportunities. Everyone will receive a call for emergency activations and response would always depend on your personal availability.



Professional Licensure, Certifications, Specialities, Experience


Expectations of MRC and CERT Volunteers (both must be selected)

Salem County MRC-CERT is open to all Salem County Residents over 18 years old. We do not discriminate and the MRC-CERT program has something that everyone can participate in regardless of physically abilities.
As a volunteer within the New Jersey Medical Reserve Corps, I will be called upon to assist in the event of a public health emergency. I agree to attend an educational program to explain my role in disaster preparedness; I will be assigned duties based on my level of training and education and experience. I understand that submitting this application does not guarantee acceptance into the NJ Medical Reserve Corps. The information contained in this application is, to the best of my knowledge, truthful. I agree to serve my fellow citizens to the best of my ability.
My submission of this application attests that I am at least 17 years of age. Applicants 17 years of age may participate in the training but will not be eligible for actual emergency deployment until they turn 18. CERT training is open to all Salem County residents. Admission to the Salem County Team after completion of the training is subject to approval of the Team Management upon submission of all appropriate documentation. I also understand that my application and completion of the training class does not require me to join the Salem County Team.
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