Human Resource

ARG ID #:

Name:

Phone:

Email:

Medical:

[ ] Licensed Veterinarian, states:

[ ] Licensed RVT, states:

[ ] Licensed MD, states:

[ ] Licensed MSW, states:

[ ] Other professional: License type:

States Where licensed:

Credentials: FEMA Courses completed: [ ] IS10 [ ] IS11 [ ] IS100 [ ] IS111 [ ] IS200 [ ] IS700 [ ] IS800 Other:

Skills:

[ ] Computer

[ ] Communication

[ ] SA handling

[ ] LA handling

[ ] Exotic handling

[ ] Shelter management

[ ] Food service management

[ ] Waste managemen

[ ] Logistics

[ ] Customer service

[ ] Animal rescue

[ ] Kennel help

[ ] Barn help

[ ] Peer counseling

[ ] First aid & CPR

[ ] Firefighter

[ ] Law enforcement

[ ] Bookkeeping

[ ] Lawyer

[ ] Search & rescue

[ ] Other     

[ ] Other     

Equipment Resource

[ ] Truck & animal trailer

[ ] Vehicle & other trailer

[ ] Back hoe

[ ] Dump truck

[ ] RV

[ ] Generator

[ ] ATV

[ ] Golf cart

[ ] Porta-potty

[ ] Mobile kitchen

[ ] Veterinary mobile clinic

[ ] 9+ passenger vehicle

[ ] Water truck

[ ] Flatbed truck

[ ] 20'x20'+ tent

[ ] Solar fridge

[ ] Other     

[ ] Other     

[ ] Other     

Non Dated Supply Resourced

[ ] Veterinary medical supplies

[ ] Human first aid supplies

[ ] Human food supplies

[ ] Barn supplies

[ ] Kennel supplies

[ ] Human housing supplies

[ ] Other     

[ ] Other     

[ ] Other     

Dated Supply Resource

[ ] Veterinary medical supplies

[ ] Human first aid supplies

[ ] Human food supplies

[ ] Hay

[ ] Dog food

[ ] Cat food

[ ] Exotic animal food

[ ] Other   

[ ] Other     

[ ] Other     

Details:

Date:

Initials of person entering information into database: