CP-12 Skills Assessment - Emergency Management Specialist (0089) See instructions on page 5 Section I Personal Information – 1 Name: 2 Date: 4 Pay Plan, Series, & 3 Job Title: Grade (e.g. GS-0089-12) 5 Current Organization: 6 Description of Current Position: Explosives safety advisor 7 Total Years Experience in 8 Total Years Experience in Emergency Management Emergency Management: Position: 9 College Degree 10 College Credits in EM Field Section II Professional Certifications – 11 Certification 12 Effective Date a b c Section III Level 1 Skills (Please evaluate and provide evidence of skills)… – 15 14 16 17 18 13 Course Completion Equivalent Creditable Date Course Length Status Training Experience Completed (hrs) Army Civilian Foundation Basic a CAC Leavenworth 1-250-AODC DL b IS-100 Fwa c IS-120.a d IS-130 e IS-200.b f IS-230.d g IS-454 h IS-546.a i IS-700.a j IS-800.b k Section IV Level 2 Skills – 21 22 23 24 19 20 Course Equivalent Creditable Date Course Completion Status Length Training Experience Completed (hrs) 1 MEDCOM 0089a
CP-12 Skills Assessment - Emergency Management Specialist (0089) See instructions on page 5 Section I – Personal Information 1 Name: 2 Date: 3 Job Title: 4 Pay Plan, Series, & Grade (e.g. GS-0089-12) 5 Current Organization: 6 Description of Current Position: Explosives safety advisor 7 Total Years Experience in Emergency Management Position: 8 Total Years Experience in Emergency Management: 9 College Degree 10 College Credits in EM Field Section II – Professional Certifications 11 Certification 12 Effective Date a b c Section III – Level 1 Skills (Please evaluate and provide evidence of skills)… 13 Course 14 Completion Status 15 Course Length (hrs) 16 Equivalent Training 17 Creditable Experience 18 Date Completed a Army Civilian Foundation Basic b CAC Leavenworth 1-250-AODC DL c IS-100 Fwa d IS-120.a e IS-130 f IS-200.b g IS-230.d h IS-454 i IS-546.a j IS-700.a k IS-800.b Section IV – Level 2 Skills 19 Course 20 Completion Status 21 Course Length (hrs) 22 Equivalent Training 23 Creditable Experience 24 Date Completed 1 MEDCOM 0089a
CP12-EM-Skills-Assessment-Form-2_V2-6-Nov-2017.docx