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Morris County Medical Reserve Corps

Morris County MRC Medical Volunteer Application

Personal Information

Date of Birth

Date Picker

Enter at least one phone number:

Do you currently serve in the National Disaster Medical System?

Do you possess a valid driver's license?

Are you at least 18 years old?

Are you a U.S. citizen?

Employment Information

Emergency Contact

Enter at least one phone number for your emergency contact:

Additional Information

Professional Licensure, Certification, Specialties and Experience

Has your professional license or certification ever been suspended or revoke in New Jersey or any other state?


Training/Continuing Education

Do you have any of the following skills?

Have you completed any training or continuing education programs in the following areas?

Expectation of NJ Medical Reserve Corps Professional Health Volunteers

As a volunteer with the New Jersey Medical Reserve Corps, I will be called upon to assist in the event of a public health emergency. I agree to attend an education program to explain my role in disaster preparedness; I will be assigned duties based on my level of training and experience. I understand that submitting this application does not guarantee acceptance into the NJ Medical Reserve Corps. The information contained in this application is, to my knowledge, truthful. I agree to serve my fellow citizens to the best of my professional ability.

I agree to the above statement. Failure to agree to the above statement invalidates application.


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