Haz-Mat Team Application

Haz-Mat Team Application
Full Name:*
E-mail:*
Telephone Number:*
Address:*
Date of Birth*

MonthDayYear
Name of Sponsor #1 (sponsor must be a member of the HazMat team)

First NameLast Name
Sponsor #1 Phone Number
Fire Company/Department Affiliation*
The team will need your department/company fire chief to fill out the "Haz-Mat Team Member in good standing and Respirator Use Clearance Form " at:

https://form.jotform.com/210756166150956
Last Fire Department/Company Physical:*
Physical by Whom:*
Prior HazMat Training (please list) please be advised the minimum qualification requirements is Basic Exterior Firefighting Operations w/ HazMat First Responder Operations*
NY State Fire Training ID# (Example NY0000000)*
Should be Empty: