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Ticket Cop

 

This form is for applying to go and work to help out Law Enforcement Officers in disaster stricken areas.  Currently we are working with the New Orleans Police Department.

If you're willing to work, we will find something for you to do.  We need people that know how to do everything involving building a house.  Plumbing, Electrical, Carpentry...etc.  You do not need to be a master at it.  You do not need to be certified.  We have people that will certify your work.

Qualifications?  You NEED to be in Law Enforcement or other valid emergency service

OR

MILITARY

OR

Have a Family Member or friend that is in Law Enforcement or other valid emergency service or military that is going on the trip. 

Family members will be given slots ONLY if there is room.  We will do our best.

You will need ID.  You will need to pass a background check.  That's it.

 Ready to go?  Feel free to fill out this form.

NOTE:  All information is strictly confidential.  None of it will be given to anybody.

Can't go but would like to donate a service or product?  Click here.

Click Here for what will be expected of you.

 

 

About You

 

What is your name?  

 

Where do you live?

       Address:   
 
    Town/City:  
 
                      State:      Zip/Postal Code:   
 

What is your D.O.B.?                                     Year:  (4 digits)

            

List your Shield Number (if applicable):   (This will be your ID/reference number)

 

What size shirt do you wear?                   

 

Are you a Male or Female?        

 

 

Tell us how to get in touch with you:

E-mail    
Tel   xxx-xxx-xxxx
Mobile   xxx-xxx-xxxx
FAX   xxx-xxx-xxxx
Best time to contact you

 

Are you in Law Enforcement or other valid emergency service?

            Yes No

 

If you answered YES, what branch are you in?  

 

IF you checked NO above, what is the name of the person you know going?

     Name of Person going:   

 

 

Have you ever been in any of the ARMED FORCES?

            Yes No

IF you checked YES above, please list which one?

           

 

Who do we contact in case of an Emergency?

       Address:   
 
    Town/City:   
 
                      State:        Zip/Postal Code: 
 
          Phone:      

 Contact Name/Relationship:    

 

 

 

Your Work

Where do you work?  

 

         Address:   
 
      Town/City:   
 
                        State:     Zip/Postal Code:          

 

 

What are you good at?

                Select all that apply.  If you can't pick any, that's still ok.  We'll still find a place for you.  We will need "Gophers", people to move supplies around,  and people to hold items while they are being placed.

       

Electrical 

Plumbing

Carpentry

Landscaping

Masonry

Windows

Painting

Heavy Machinery

Drywall

Tiling

Contractor

Cabinets/Kitchens

  Roofing

Flooring

Carpeting

Mold Removal

Spackling

Insulation

Central Air

General use of tools

CAT-5

Cable

Telephone

Lighting/Ceiling Fans

 

If you picked any of the following trades, please list your level of experience:

Electrical  - Level of Experience:  Years of Experience: 
Plumbing   - Level of Experience:  Years of Experience: 
Carpentry  - Level of Experience:  Years of Experience: 
Tiling   - Level of Experience:  Years of Experience: 

 

Are there any other trades you're good at? 

 

What will you need to bring?  We ask that everyone try to bring the basics.  Please check that you have the following:

 

 

           - Hammer                            - Screwdriver (Both Flat and Phillips)

              -  Wire cutters                    - Tool Belt

              -  Utility Knife                     - Screw Gun (If you have one)      

           - Pliers (linesman)             - Measuring Tape

              -  gloves                             -  Sheetrock Utility Saw

 

 

How's you health?

 

Do you have any health conditions that might impair your trip or volunteer work ?

            Yes No

 

Have you ever had to take sick time for these health conditions that would affect your trip or volunteer work?

            Yes No

 

If you answered "Yes" to either question above, please explain in the box below:

         

 

 

Do you have any allergies?  Please include medications you are allergic to:

            Yes No

If you answered "Yes" to the question above, please explain in the box below:     

         

 

 

Mold is a big issues in areas affected by water, such as New Orleans.  Have you ever had a reaction to mold or do you have any concerns about being around mold?

            Yes No

If you answered "Yes" to the question above, please explain in the box below:

 

 

Do you understand that in places, such as New Orleans, temperatures can reach up to 100 and higher with high humidity?

            Yes No

 

 

Do you have any respiratory problems?

            Yes No

If you answered "Yes" to the question above, please explain in the box below:

 

 

Do you have any cardiac problems?

            Yes No

If you answered "Yes" to the question above, please explain in the box below:

 

 

Do you have any type of back problems?

            Yes No

If you answered "Yes" to the question above, please explain in the box below:

 

 

Do you feel you are in good physical condition?

            Yes No

 

 

Do you have any type of medical training?

            Yes No

 

Please explain your level of training and any certifications you hold (if applicable).

 

 

When would you like to go?

 

Please Click here to see a calendar to help you look up dates:

    

In the boxes below are trips that are either confirmed or in the making.  If you would like One of these confirmed/suggested dates, please chose one:

           

 

If you would like to try to have us consider a trip on a date OTHER than above OR if you have at least 8 people already and would like to form a trip (It can be an "only" trip.  Ex - If you'd like just a Lieutenant only, Sergeant only, a precinct only, firefighter only...you get the idea).  You can also begin a trip and we can add to it.

                               

 

Are you interested in helping out for more than one week?

            Yes No

 

Travel Info:

          In case you are selected and flying, we need to know what airports service your area:

 

AIRPORT NAME/CITY LOCATION

DISTANCE AIRPORT CODE (IF KNOWN)
1.     HOURS/MILES  
2.     HOURS/MILES  
3.     HOURS/MILES  

 

Airlines info:

          As an added benefit, we try to apply air miles to each person.  If you have any airline mile accounts you would like applied, please let us know.   If we can add them, we will.  This way you get credit for the trip.  The most common airlines we use are: American, United, and Delta.  List any you have and if you'd like, register for these.  We will do our best.

 

AIRLINE NAME

MILEAGE NUMBER
1.    
2.    
3.    

 

 

 

After you click "Submit comments."  you will be taken to a confirmation page and given a chance to sign up for our forum.

 

We also have a forum so you may:

 

   - Discuss your trip with others going the same time you are.

   - Discuss job issues

   - Meet people

   - Learn

   - Discuss things from the job you may have seen or experienced that are "weighing you down"

 

  After you click submit, please go to our forum section and sign up there also.  You will have to enter some information that is the same, but we do this so the forum can remain anonymous.

 

 

 

 

 

Ticket Cop

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