Greene County HAZMAT Team Application

Greene County Hazmat Team Application

Full Name: *

E-mail: *

Telephone Number: *

Address: *

Date of Birth *

Month Day Year

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

First Name Last Name

Sponsor #1 Phone Number

Area Code Phone Number

Name of Sponsor #2 (sponsor must be a member of the HazMat team)

First Name Last Name

Sponsor #2 Phone Number

Area Code Phone Number

Fire Company/Department Affiliation: *

The team will need a letter of recommendation from the department/company fire chief. This letter can be presented to the team during the interview process.

Last OSHA Physical: *

Physical by Whom: *

Prior DECON Team/HazMat Training (please list) *

NY State Fire Training ID# (Example NY0000000) *