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IMERT membership requires the ability to meet a moderate physical fitness requirement defined as occasional fieldwork performed by individuals with average endurance and physical conditioning. Disasters occasionally demand moderately strenuous activity over long periods of time. Activities include standing for long periods, walking, stooping, and moderate lifting. Long hours of work may be necessary

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize the investigation of all matters contained in this application and hereby give permission to contact employers, references, and others in order to verify the facts and information furnished with regard to my character and qualifications, and hereby release and indemnify IMERT from any claims or liability as a result of such contact. I also hereby release my employer, references, and other persons from all liability in responding to inquiries in connection with this application. I understand that misrepresentation or omission of facts may result in rejection of this application, or if admitted, discipline up to and including dismissal. I understand that IMERT reserves the right to conduct a background check on all of its members at the time of acceptance to the team as well as periodically throughout their tenure as team members per the direction of IMERT. I understand that filling out this form does not indicate I am member or representative of IMERT and does not obligate IMERT to accept my membership. I understand that my tenure with IMERT is for no specific term, is dependant upon completion of annual membership requirements, and may be terminated by myself or IMERT with or without notice or cause at any time.