NEVIS DISASTER MANAGEMENT DEPARTMENT (NDMD)

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About
Hazards & Disasters
Shelters
Disaster Management
News & Weather
Forms
Contacts

Volunteer Application Form

Nevis Disaster Management Department (NDMD) / Volunteer Application Form

PERSONAL DETAILS

Title(required)

Mr.

Mrs.

Miss

Dr.

Other

Other(required)

please specify

Gender(required)

Male

Female

Name(required)

first, initial, last

Email address (Personal)(required)

Email address (Work)

Telephone (Home)

Telephone (Mobile)

Telephone (Work)

Address(required)

Do you have a child (ren)?(required)

No

Yes

How many under the age of 18 years?(required)

Do you have a Driver’s Licence?(required)

No

Yes

Driver’s Licence Class(required)

What's your Blood Type?(required)

Employment Status(required)

Employed

Self Employed

Retired

Unemployed

Place of Employment(required)

Occupation(required)

Period of Employment(required)

year(s)

Last Place of Employment

Last Occupation

Period of Emplyment

year(s)

Contact Person(required)

in case of an Emergency

Contact Telephone(required)

Do you have allergies?(required)

No

Yes

List of allergies(required)

Do you have medical insurance?(required)

No

Yes

Insurance with which company?(required)

Last formal education?(required)

Do you speak any foreign language (s)?(required)

No

Yes

List of foreign language (s)(required)

Do you have any physical disability?

No

Yes

List of disability

Do you have volunteering experience?(required)

No

Yes

VOLUNTEER EXPERIENCE

Organization

Position

Date of Service

Organization

Position

Date of Service

Organization

Position

Date of Service

TRAINING & SKILLS

List of Training and Skills

one per line

WHEN CAN YOU BE AVAILABLE?

Sunday(required)

Morning

Afternoon

Evening

Monday(required)

Morning

Afternoon

Evening

Tuesday(required)

Morning

Afternoon

Evening

Wednesday(required)

Morning

Afternoon

Evening

Thursday(required)

Morning

Afternoon

Evening

Friday(required)

Morning

Afternoon

Evening

Saturday(required)

Morning

Afternoon

Evening

AREAS OF COMPETENCE

Areas of Competence(required)

Medical/Health Care (Fist Aid/CPR)

Sign Language

Individuals with Disabilities

Construction

Shelter Management

Heavy Equipment Operator

Rapporteur

Information Technology

Administration

Counsellor

Search & Rescue

Home Care (Child & Elderly)

Radio Communications

Catering

Transportation

Social Work

Damage Assessment

Data Collection

Photography

Other

Other Area(s) of Competence(required)

one per line

BENEFITS OF VOLUNTEERING

Were you ever a NDMD volunteer?

No

Yes

For how long?(required)

Why do I want to become a volunteer?(required)

How can I benefit?(required)

REFERENCES

#1. Name of Reference(required)

Reference Job Title(required)

Reference Contact Number(required)

#2. Name of Reference(required)

Reference Job Title(required)

Reference Contact Number(required)

Are you human?(required)

This field should be left blank

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NDMD CONTACT

P. O. Box 280,
Ministry of Agriculture et. al.,
Long Point, Nevis, West Indies Phone: 469-1423 (24/7) / 469-7903 Fax: 469-5407 Mobile: 668-6401/764-7567 E-Mail: info@ndmd.kn

POLICE & FIRE STATIONS

Emergency: 911 Charlestown Police: 469-5391/2 Gingerland Police: 469-3448 Newcastle Police: 469-9326 Cotton Ground Police: 469-5269 Charlestown Fire: 469-3444 V.W.A. Airport Fire: 469-8606

HOSPITAL/HEALTH CENTRE

Alexandra Hospital: 469-5473 Charlestown: 469-5521 Brown Hill: 469-5521 Gingerland: 469-5521 Butlers: 469-8254 Camps: 469-9323 Cotton Ground: 469-5521

IMPORTANT CONTACTS

Water Dept: 469-5324 PWD: 469-5521 ext. 2026 NEVLEC: 469-9100 or 662-5811 Red Cross: 469-5961 Nevis Air & Seaport: 469-2001 Nevis Solid Waste: 469-1762 Coastguard (St. Kitts): 465-9279

Copyright - Nevis Disaster Management Department (NDMD).