HICS 253 - Volunteer Staff Registration

1. FROM DATE/TIME

2. TO DATE/TIME

3. SECTION

4. TEAM LEADER

5. REGISTRATION
Name
Last Name, First Name 		Address
City, State, Zip
Soc. Sec. Nbr.
Tel. Nbr. 		Certification/Licensure and Number Time
IN 		Time
OUT 		Signature
6. CERTIFYING OFFICER 7. Date/Time Submitted:
8. Facility Name

Purpose : Volunteer sign-in for operational period
Origination : Labor Pool & Credentialing Unit Leader HICS 253
Copies to : Time Unit Leader, Personnel Tracking Manager, and Documentation Unit Leader

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