Uploaded on

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
159
On Slideshare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
1
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. CERTIFIED EMERGENCY RESPONSE CHAPLAINS I.D. CARD APPLICATION/RENEWAL (Please Print Clearly)Name:_________________________________________________________________________________ (Last) (First) (M.I.) StreetAddress:__________________________________________________________________________City:_______________________________________________ State:________ Zip:________________E-mail Address:__________________________________________________________________________Phone: (_______)________________________________ CERC & ERCC HQ USE ONLYDate of Birth:____________________________________ (YYYY) (MM) (DD)Hair Color:___________________ Height:___________Eye Color:___________________ Weight:___________Signature:______________________________________ Date:_______________________________Submission Option (1): Print this form. Fill in all information. Mail completed and signed form, 2 passport photosto (ERCC) to: Chaplain (LTG) John D. Butler / ERCC/CERC P.O. Box 3332 Kinston, NC. 28502-3332Submission Option (2): Print form. Fill in all information. PDF or scan completed and signed form, and emailform and photo (JPEG format) to chaplain_andrew@yahoo.com.Photo Option (1): Obtain passport photos from the Post Office, Walgreens, UPS, Wal-Mart or other commercialvendor. Cost is approximately $9.00 for 2 photos. Mail 1 photo with completed and signed form to the addressabove.Photo Option (2): Provide a JPEG photo via email. If you choose this option you MUST strictly adhere to thefollowing guidelines:  Take the photo against a plain white or off-white background  Photo must be full face, front view from top of head to just below the shoulders  Face in photo should have a natural expression; eyes open, mouth closed, not smiling  Wear a light colored (white preferred) button-up dress shirt/blouse with top button open  No clergy attire, uniforms, sunglasses, hats or scarves permitted