DCS-22 Contact / Capabilities Survey

This form is intended for use by registered members of DCS-22 to assist in maintaining current information regarding how you may be contacted and your capabilities / availability. Please complete the following questionaire supplying all of the information you can. You should also use this form to report changes in information previously supplied.

Information supplied on this form is subject to the DCS-22 Privacy Policy and will not be provided or sold to any other agency, group, or individual. Completion and submittal of this form indicates acceptance of this policy and grants DCS-22 authority to use the data accordingly. Questions regarding the privacy of personal data should be directed to K-01.

* Required Information
  Version 2.12 Personal Data
* Amateur Callsign:
  License Class: Extra Advanced General Tech Plus
Technician Novice
  License Expires: mm/dd/yy
* DCS-22 Unit Identifier: K-### Number:
  LASD Volunteer #: Number starting with V on LASD Volunteer ID Card
* eMail Address:
* Last Name:
* First Name:
  Middle Initial:
  Nick Name:
* Is this an update to a prior Registration? Yes
No
  Mailing Address:
  City:
  State:
  Zip Code:
  Telephone
Numbers:
Home:
Work: Ext:
Mobile/Cell:
FAX:
Pager:
  Preferred
Method
of
Contact:
Home Telephone
Work Telephone
Mobile/Cell Telephone
Pager
Other:
  Text Alerting

If you want to be included in any of the SMS Text Alerting Systems, please provide your Mobile number above and the following data:
Cellphone Service Provider: ATT/Verizon/Sprint/etc.

SMS Alias, if used:

1. Entering this data will automatically add you to the DCS-22-Alert system.
2. QDT Members will be added to the DCS-22-QDTAlert system.
  Primary Frequency Monitored: MHz.
  Employment: Employer:
City:
eMail:
  Notify in Emergency: Name:
Telephone Number(s):
Relationship:
  Do you have any Special Medical Condition? No
Yes - Explain
  Normal Availability Hours:

Please indicate those hours you are most likely to be available Monday through Friday.
0001-0600
0601-1200
1201-1800
1801-2400
Other
 
    Transportation
Check those that apply
  Vehicles Available for Emergency Use: Car
Pick-up
SUV
Van
ATV
Other
  Drivers License: Valid US Drivers License
LASD Trained
DCS-22 Van Training
Other
 
    Emergency Preparedness Training
Check only those that apply and are current
    LASD Basic DCS
LASD Traffic
LASD Shadow Operator
LASD Officer Safety for Volunteers
FEMA IS-100 - Intro to ICS
FEMA IS-111 - Livestock in Disasters
FEMA IS-200 - ICS for Small Resource Incidents
FEMA IS-700 - Intro to NIMS
FEMA IS-800 - Intro to NRF
CERT
CPR
First Aid
CHP Traffic
LA Fire
Licensed Medical Personnel
HASMAT
Other
 
    Equipment Availability
Check only equipment in operting condition
  Home (Fixed) Station; 75-10 Meters
6 Meters
2 Meters
222 MHz
440 MHz
1.2 GHz
ATV
CB 11 Meters
General Mobile Radio Service
Multi Use Radio Service
Other
  Mobile (Installed or Portable): 75-10 Meters
6 Meters
2 Meters
222 MHz
440 MHz
1.2 GHz
ATV
CB 11 Meters
General Mobile Radio Service
Multi Use Radioi Service
Other
  Handheld: 6 Meters
2 Meters
222 MHz
440 MHz
1.2 GHz
ATV
CB 11 Meters
General Mobile Radio Service
Family Radio Service
Multi Use Radio Service
Other
  Emergency Power: Home Generator KW
Portable Generator KW
Portable 12V Battery
Other KW
  Portable Antennas: HF: HF Vert HF Beam HF Wire Ant
- Bands
6M: Vert Beam
2M: Vert Beam
222MHz: Vert Beam
440MHz: Vert Beam
1.2GHz: Vert Beam
Other: (Describe)
 
    Capabilities
Check the level of your ability/interest
  Message Handling Experience: None Low Medium High
  Directing Other People: None Low Medium High
  Working at Night: None Low Medium High
  Electronic Repair Experience: None Low Medium High
  Ability to Install Antennas: None Low Medium High
  HF Experience: None Low Medium High
  Programming HT's: None Low Medium High
  Willingness to do non-radio tasks: None Low Medium High
  Generator Experience: None Low Medium High
  Telephone Experience: None Low Medium High
  Computer Skills: None Low Medium High
  Sign Language: Yes No
  Languages: Read Speak
Read Speak
 
Please list any additional skills here:
 
  Do you want to receive DCS-22 Messages
via eMail?
Yes
No
  Do you want to receive the DCS-22 Newsletter
via eMail?

NOTE: Not currently being published.
Yes
No
 
 
Other Comments: