Training Request Form printable pdf download

Stafford County Fire & Rescue Department

1225 Courthouse Road – Stafford, Virginia 22554

Phone: (540) 658-7200 Fax: 540-658-4545

TRAINING REQUEST FORM

APPLICANTS: Please complete this form and forward to your Station Chief or Training Officer,

If approved, the Station Chief or Training Officer will submit the approved application to

SCFRDTRAINING@co.stafford.va.us

COURSE INFORMATION

Course Requested: _________________________________________________________________________________

Starting Date of Course: ______________ Course Location: ______________________________________________

STUDENT INFORMATION

Full Name: ________________________________________________ Rank: _________________________________

Male:

Female:

Date of Birth: ____________________ Last 4 of Social Security #: ______________________

Home Address: ____________________________________________________________________________________

Primary Phone #: _______________________ E-Mail: __________________________________________________

Check One:

Volunteer:

Career:

Non-Fire/Rescue:

Jurisdiction/County: ______________________

Department Name: ___________________________________________ Stafford County ID Number: ______________

Highest Level Certification

FIRE: _______________________________ EMS : _______________________________

Comments:

*All Students must be a minimum of 16 years of age for all programs, and at least 18 years of age for all HTR Courses

NOTICE

IMPORTANT: This Training Request Form will ONLY be accepted if a training announcement has been posted.

Training Requests not completely filled out will be returned for re-submittal, which may result in rejection due to limited

class size.

Understand that certain segments of this training may be physically demanding. If you have any questions on the physical

requirements, or if you need special accommodations to complete the program’s activities, please notify the Course

Coordinator immediately.

If accepted into the training program, understand that it is your responsibility to attend all required classes.

TRAINING DIVISION USE ONLY

Date Received: _____________ Comments:

___________________________________________

_______________________

Approved

Denied

Training Division Signature

Date

Training Request Form