Hawaii Emergency Management Agency

APPLICANT Applicant's Name (Last, First, Middle Initial):
Type of Employee:
Organization Name:
Department Name:
Job Title or function:
Organization role during emergency operations (be specific):
Work Telephone#:
Cell Phone:
Email Address (Used as login username - Single User):
Supervisor's Name:
Supervisor's Email:
User Type:

REQUEST Requested Board(s):

End-User Agreement:

As an authorized user of HI-EMA WebEOC, I agree to use the requested system in full accordance with HI-EMA policies and procedures and to protect all information from unauthorized disclosure. I agree not to share my user sign-on (sign-on name and password) with anyone at any time. I understand that unathorized use or disclosure of HI-EMA Services information will result in the immediate termination of my user privileges and may include civil and criminal penalties.