|
Office of the
|
Fire Department
|
| Name of Fire Department Contact Phone No. |
|
|
Four/Six
digit location code |
The
department is composed of Full-time Firefighters  Volunteer Firefighters
 Composite |
As Fire Chief, I declare the intent of my department to participate in the Company Officer Certification Program.
Attached is a list of _____________________Company Officers in
the department (complete with their full names,
(state the total number)
date of
eligibility as a Company Officer and classification) who will be seeking
certification.
|
Name of
Fire Chief:____________________________________________________________ |
|
Signature:________________________________________________________ |
|
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