<p> Attachment 4</p><p>Emergency Management Division 2014 Annual EOC Credential Application</p><p>Please ensure you are on the Authorized List submitted to EMD by your ESF Lead </p><p>Name: ______(Check one) New EOC Personnel Renewal EOC Position: (i.e. ESF 2 Supervisor, Supervisor) </p><p>______</p><p>Municipality/Department/Agency: </p><p>______</p><p>ESF #/Unit/ Section or Area of Assignment: </p><p>______</p><p>ESF Lead/Unit Supervisor: </p><p>______</p><p>Work Address: </p><p>______</p><p>Email Address: ______</p><p>Cell Phone: ______Work Phone: ______FAX: ______</p><p>(Check one) □ I do not have a Johnson Controls access card. □ I currently have a Johnson Controls access card and the number (back of card, top right corner) is: ______</p><p>I agree to adhere to the EOC Policies and Procedures posted in the Broward County on- line WebEOC File Library. EMD STAFF USE ONLY: Certificates Provided: </p><p>IS 100___ IS 200___ ICS 300___ ICS 400___ IS 700___ IS 701___ IS 702___ IS 703___ IS 704 N/A IS 706___ IS 800____ </p><p>WebEOC (Classroom) ____ WebEOC (On-Line) _____</p><p>ID Approved____ ID Denied ____ Reason______</p><p>EMD Evaluator______Attachment 4</p><p>Name (Print) ______Signature ______</p><p>Date ______</p><p>Credentials will not be issued without the proper documentation. For additional information or to schedule an appointment, please contact Penni Weinstein-Long at 954-831- 3903 or [email protected] Credentials are processed and issued at the EOC: Emergency Management Division 201 NW 84th Avenue, Plantation, FL</p><p>Please contact Penni directly if you need a new ID</p><p>*******************************************************************************************************</p><p>EMD STAFF USE ONLY: Certificates Provided: </p><p>IS 100___ IS 200___ ICS 300___ ICS 400___ IS 700___ IS 701___ IS 702___ IS 703___ IS 704 N/A IS 706___ IS 800____ </p><p>WebEOC (Classroom) ____ WebEOC (On-Line) _____</p><p>ID Approved____ ID Denied ____ Reason______</p><p>EMD Evaluator______</p>