Prescreen
Before proceeding to the full application, please take a moment to complete the prescreening questions below. These questions help us ensure that:
-You meet the qualifications for participation,
-Your region is currently accepting applications, and
-You understand the expectations of being part of this team.
⚠️ Important: Only applicants who meet the qualifications and are applying from an active region will be invited to complete the full application. If your region is not currently open, we encourage you to check back in the future as we continue to expand.
What region are you applying for?
(Required)
Please select the region that best represents the location where you live or serve.
Region 1 (ATCHISON, ANDREW, BUCHANAN, CALDWELL, CLINTON, DAVIESS, DEKALB, GENTRY, HARRISON, HOLT, MERCER, NODAWAY, WORTH)
Region 2 (ADAIR, CHARITON, CLARK, GRUNDY, KNOX, LEWIS, LINN, LIVINGSTON, MACON, MARION, MONROE, PIKE, PUTNAM, RALLS, RANDOPH, SCHUYLER, SCOTLAND, SHELBY, SULLIVAN)
Region 3 (CARROLL, CASS, CLAY, JACKSON, JOHNSON, LAFAYETTE, PETTIS, PLATTE, RAY, SALINE)
Region 4 (BATES, BENTON, CEDAR, DALLAS, HENRY, HICKORY, POLK, ST. CLAIR, VERNON)
Region 5 (AUDRAIN, BOONE, CALLAWAY, CAMDEN, COLE, COOPER, HOWARD, LACLEDE, MILLER, MONITEAU, MONTGOMERY, MORGAN, OSAGE)
Region 6 (FRANKLIN, JEFFERSON, LINCOLN, ST. CHARLES, ST. LOUIS, ST. LOUIS CITY, WARREN)
Region 7 (BOLLINGER, CAPE GIRARDEAU, IRON, MADISON, PERRY, ST. FRANCOIS, STE. GENEVIEVE, WASHINGTON)
Region 8 (BARRY, BARTON, CHRISTIAN, DADE, GREENE, JASPER, LAWRENCE, MCDONALD, NEWTON, STONE, TANEY, WEBSTER)
Region 9 (CRAWFORD, DENT, DOUGLAS, GASCONADE, HOWELL, MARIES, OREGON, OZARK, PHELPS, PULASKI, SHANNON, TEXAS, WRIGHT)
Region 10 (BUTLER, CARTER, DUNKLIN, MISSISSIPPI, NEW MADRID, PEMISCOT, REYNOLDS, RIPLEY, SCOTT, STODDARD, WAYNE)
Unfortunately applications are not currently being accepted for that region.
Please check back soon or check the website for updates as new regions open. We look forward to your future application!
Great! Your region is currently accepting applications.
Please continue with the next set of questions.
Please indicate which category best describes you:
For category definitions, please
Click Here
First Responder - Active or retired firefighter, law enforcement officer, emergency medical services, communications/dispatch, or corrections officer. (If selected, you will be asked to specify: Full-time, Part-time, or Retired)
Chaplain
Behavioral Health Professional
First Responder Spouse or Companion
None of the Above
Thank you for your interest. At this time, you do not meet the eligibility criteria for participation in the Critical Incident Support Network.
Background Check
Do you have at least 3 years of experience in your field, including at least 1 year with your current department?
(Required)
If a first responder spouse or companion, please indicate if you have been in a relationship with a first responder for at least 3 years.
Yes
No
Please consider applying once you have met the required experience.
Has your department or agency leadership granted you approval to participate in the Critical Incident Support Network regional team?
(Required)
Yes
No
Please obtain departmental approval before applying.
Have you had any formal disciplinary actions in the past 12 months that could impact your participation in this team?
(Required)
Yes - You may be eligible to apply 12 months after the conclusion of any disciplinary action.
No
Please explain your disciplinary action.
(Required)
Are you willing and able to respond to crisis situations (which may occur outside normal work hours), and to attend regular team meetings and required training?
Yes
No
We understand life can be demanding. Please consider applying when your schedule allows for full participation.
CISN Application
Thank you for your interest in joining the Critical Incident Support Network. Please complete the following application in full. Incomplete applications may not be considered. All submitted information will be kept confidential.
Personal Information
Name
(Required)
First
Last
Home Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Date Of Birth
(Required)
MM slash DD slash YYYY
Email
(Required)
Preferred Contact Email
Cell Phone
(Required)
Preferred Contact Phone Number
Home Phone
What Is your current role?
(Required)
Full Time First Responder
Part Time First Responder
Retired First Responder
Chaplain
Behavioral Health Professional
Spouse/Companion of First Responder
Clarification for Behavioral Health Professionals:
Individuals who are trained to provide counseling and / or therapeutic interventions. This includes Level 2 Community Behavioral Health Liaisons (CBHLs) and licensed behavioral health professionals who have been vetted for their suitability to work with first responders. These professionals are trained to address the unique emotional, psychological, and behavioral challenges faced by individuals in high-stress, trauma-exposed occupations. They are equipped to help first responders cope with the effects of critical incidents, trauma, and the cumulative stress associated with their work. They offer individualized treatment, crisis intervention, and long-term support to promote mental well-being and resilience within the first responder community.
Do you meet this requirement?
Yes
No
Thank you for your interest. Please consider applying if you meet these criteria in the future.
This includes:
-
Level 2 Community Behavioral Health Liaisons
(CBHLs) who are part of the Missouri State Highway Patrol DEFENSE program, and
-
Licensed behavioral health professionals
(e.g., LPCs, LCSWs, psychologists, etc.)
Department / Supervisor Contact
Supervisor's Name
(Required)
Prior Supervisor If Retired
First
Last
Supervisor's Title
(Required)
Supervisor's Email
(Required)
Supervisor's Phone
(Required)
Training, Certifications and Licensures
List of relevant training to Critical Incident Stress Management, peer support services, behavioral health training and education, ministerial training and education, and related courses.
(Required)
Upload Certificates
Upload your applicable licensures, certifications, and education / training certificates. For example, POST License or Commission Card, Behavioral Health licensure, Ordination or Ministry License, Missouri Fire Fighter Certification, and Missouri EMS license.
Drop files here or
Select files
Accepted file types: jpg, jpeg, png, pdf, Max. file size: 100 MB.
Employment History
List Your Relevant Employment History
(Required)
Job Title
Employer Name
Dates Of Employment
Brief Description Of Responsibilities
Add
Remove
Describe Your Relevant Experiences
(Required)
If first responder/chaplain/clinician, describe your duties. If spouse/companion, share relationship duration & relevant experiences
Peer Support or Volunteer Experience
(Required)
List past involvement in mental health education, stress management or peer support services, or related areas.
Personal Statement
(Required)
Please tell us why you want to join the Critical Incident Support Network. (3–5 sentences)
Background Check Consent
(Required)
I authorize the First Responder Provider Network to conduct a background check as part of my application for the Critical Incident Support Network. I understand that this may include verification of my criminal history, employment records, and other relevant information. I consent to the release of such information and waive any claims against the First Responder Provider Network and its agents for obtaining and using this information. I acknowledge that this consent is a condition of my application and may be revoked in writing at any time.
I agree to the terms below.
Have You Ever Been Convicted Of A Felony?
(Required)
Yes
No
Please Explain
(Required)
Letters Of Recommendation
(Required)
Please ensure two letters of recommendation are submitted within 2 weeks:
- One from your direct supervisor
- One from a current co-worker.
(Spouse/Chaplain applicants may submit letters from professional/personal references. Retired First Responders may submit letters from former co-workers and supervisors.)
Send to:
[email protected]
I understand
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