Firefighter I & II Class Request Form
Last Name: ___________________________
First Name: ___________________________ Middle Initial:_____
Date of Birth: __________ Department (If Applicable):______________
MAILING ADDRESS
Street or P.O. Box:___________________________________________
City:___________________________ County: ____________________
State:__________________________ Zip: _______________________
Home Phone: (___) _____________ Work Phone: (___) ____________
Cell Phone: (___) ______________ E-mail: ______________________
CURRENT STATUS (Please check all that apply to you.)
____
1. Employed full-time as a paid firefighter or Public Safety Agency.
____
2. Certified Paramedic (or completed the training program).
____
3. Certified EMT (or completed the training program).
____
4. Currently attending EMT/Paramedic Class.
____
5. Active Volunteer firefighter.
____
6. Non-affiliated (those who do not meet any of the above).
Note:
You must send with this form the basic skills requirement and EMT/Paramedic certificate copies (if certified) to be considered for a class
.
CLASSES (Please check preference.)
____ January - March ____ May - August ____ August - November
Return this form with verification copies to:
Marion County School System
Community Technical & Adult Education Center
Attention Firefighting
1014 S.W. 7
th
Road
Ocala, Florida 34474
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