Emergency Response Team (ERT) Application

Thank you for expressing interest in joining as an Emergency Response Team (ERT) member. Members can be EMTs, paramedics, nurses, physicians, flight crew members (nurses, paramedics, and pilots) or other medical professionals who are deployed during disasters/large scale events. If you have any issues completing this form, please contact your Regional ERT Coordinator for assistance.


Our Emergency Response Team members are the vital component to a successful operation. Your expertise, dedication, commitment, and willingness to serve our fellow citizens is greatly appreciated and valued at the highest levels of the organization. Thank you again for all those times you put your own needs behind the needs of others.


**IMPORTANT** Before proceeding you will need to have information available to complete the form. There are sections that also require supporting documents to upload. You will not be able to submit without providing all required documents.


Information Needed for the following:


  1. Employee ID # (Oracle / Workday)
  2. Business Unit # (GL Entity Code)
  3. Driver's License information
  4. Passport information (if applicable)


Files Required to Upload:


  1. Driver's License
  2. State/Federal Certification


Attachments must be a single item per file. Uploads must be a supported file type (.doc, .pdf., jpeg, etc) They CANNOT be live photos (.HEIC).


Helpful Resources:

AMR Emergency Response Team 72-Hour Go-Kit

PERSONAL INFORMATION

TSI manages all travel for OEM deployments. It is VERY IMPORTANT that you provide your name as shown on your driver's license or government-issued identification used for travel. Please complete using proper capitalization.

IMPORTANT

Remember to enter name as it appears on your driver's license or government-issued identification that you would present to TSA at airport or ports of entry.

Leave blank if a middle initial or middle name is not listed on your ID.

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Provide an email that you will have access to pre, during, and post-deployment.

Provide a mobile number that you will have access to pre, during, and post-deployment.

Phone

Use if applicable. Leave blank if not.

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EMPLOYMENT INFORMATION

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Most GMR employees can locate this number by going to myportal.amr.net/MyInfo/ The Business Unit Number is listed under the My Work Info section on the right and is listed as the GL Entity Code. You can also contact HR to confirm the GL Entity Code assigned to your Business Unit.

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If you are eligible for overtime you are a Non-exempt (Hourly) employee. If not, you are an Exempt (Salary) employee.

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Phone

Certification Information

Enter Numbers Only - no dashes

Required for verifying clinical certifications.

This information is securely stored and will only be visible to AMR/OEM and government staff with a business need.

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In an effort to keep the communities we serve, as well as each other safe, we will be giving priority status to providers (air, ground, fire and support departments) who are fully vaccinated against COVID-19.

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TRAVEL RELATED INFORMATION

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Airports are listed by City. You can type the airport code for quick selection.

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Airports are listed by City. You can type the airport code for quick selection.

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File Upload - GMR

The following documents are required to upload:


  1. Valid Driver's License
  2. State/Federal Certification

File Upload - Air Hospital Partners

The following documents are required to upload:


Flight Paramedics-

  1. Valid State EMS License
  2. Valid CPR Card
  3. ACLS
  4. PALS
  5. Flight Paramedic Certification (FP-C) or equivalent
  6. Valid Trauma Certification
  7. Valid Driver’s License
  8. Hazmat Awareness
  9. Hepatitis B Vaccination Record or signed declination form
  10. Respirator Medical Clearance Form
  11. Respirator Fit Test Record


Registered Nurse-

  1. Valid Driver’s License
  2. Valid RN State License
  3. ACLS Card
  4. PALS Card
  5. CFRN or equivalent
  6. Valid Trauma Certification
  7. Hepatitis B Vaccination Record or signed declination form
  8. BLS card
  9. Respirator Medical Clearance Form
  10. Respirator Fit Test Record


Respiratory Therapist -

  1. Valid Driver’s License
  2. CRT or equivalent
  3. Valid CPR Card
  4. ACLS Card
  5. PALS Card
  6. Hepatitis B Vaccination Record or signed declination form
  7. Respirator Medical Clearance Form
  8. Respirator Fit Test Record

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I understand that this a voluntary assignment and I am indicating my interest to be considered for a deployment.

I understand that this expression of interest is not binding on me or the Company, and I understand that I may or may not be asked to serve in this capacity.

I acknowledge that I am fully qualified to function in the position(s) applied for based on the minimum criteria cited herein.

I understand that should I be asked to deploy, some aspect of my employment will change during the period I serve, including my shift, number of hours worked, compensation, and working conditions.

If I am a unionized employee, other terms, conditions, and/or obligations may or may not apply.

Except as provided herein, this does not change the terms and conditions of my employment with the Company or create an employment contract.

I understand that I must deploy within 6 hours of notification and be able to be on-site where needed within 24 hours (travel arrangements will be made and paid by OEM).

I understand that if deployed, the duration of the assignment is based on the size of the situation.

I understand that I may be deployed as an IMT, OST, or CST member that I may be asked to serve in other capacities based on the needs of the situation.

All aspects of the deployment are confidential, no information will be released or shared (to include social media) without written consent from NATCOM.

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Please enter your full name.

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