Other Qualified Personnel RegistrationWho should register? Private sector employees who serve in a key health care, security or critical infrastructure protection role within the JRIC area of responsibility. Notification email address must be company / organization affiliated. Please complete all required information and refrain from using abbreviations and typing in all CAPS.
(Please, no personal e-mail addresses.)
CONTACT INFORMATION(for registration purposes only)First Name *Last Name *Position/Title: *Phone Work: *Mobile Phone:Email Address: *(Use company / organization email address)Retype your e-mail address: *
AGENCY / ORGANIZATIONAgency/Organization Name: * (no abbreviations)Current Assignment: *(Spell out - no acronyms)Address: *Address 2:City: *County: * - Select County -Los AngelesOrangeRiversideSan BernardinoSanta BarbaraSan Luis ObispoVenturaOther
State:*Zip code:*SUPERVISOR INFORMATIONSupervisor Full Name: *Supervisor Phone: *Supervisor Email Address: *WEBSITE ACCESSPassword: *(Create a password for site / must be 8 characters minimum 1 numeric and 1 special)All registration information is considered strictly confidential.