TRAINING REQUEST FORM
Please provide as much advanced notice as possible. The sooner a request is submitted, the greater the likelihood of approval.
Name
*
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
*
example@example.com
Station/Shift Assignment:
*
Station 100/FTC
Station 110
Station 120
Station 130
Station 140
Station 150
A Shift
B Shift
C Shift
Day Shift
Are you a resident firefighter?
Yes
No
Is this request for a College/CBC Course or EMT Course?
Yes
No
Are you a salaried employee?
Yes
No
Will you be on straight time? (Salaried Employee)
Yes
No
Number of Hours and Dates:
Is a backfill required? (Salaried Employee)
Yes
No
Number of Hours and Dates:
Is overtime required? (Salaried Employee)
Yes
No
Number of Hours and Dates:
Training Information:
Complete all information with as much detail as possible. *Incomplete information will result in automatic denial of request
Title of Training:
*
Destination:
*
Agency Hosting Training:
*
Departure Date:
*
-
Month
-
Day
Year
Date
Departure Time:
*
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
:
Hour
00
10
20
30
40
50
Minutes
Return Date:
*
-
Month
-
Day
Year
Date
Return Time:
*
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
:
Hour
00
10
20
30
40
50
Minutes
*Attach a copy of the class flyer including itinerary, dates, and times.
*
Browse Files
Cancel
of
If there is no attachment check box below:
A flyer was not issued for this class.
Is the Training mandatory? (Required by Benton County Fire District #1)
*
Yes
No
Is the training required for certification/recertification?
*
Yes
No
Other
If Yes, by whom is it required (MPD, State, CE, etc.)?
Will training provide CE credits?
*
Yes
No
If Yes, by whom?
Training Fees and Travel Costs:
Is there a cost for Tuition/Registration?
*
Yes
No
Other
If yes, what is the cost?
Is a District vehicle needed?
*
Yes
No
Other
Lodging: Number of nights needed?
What is the cost per night for lodging?
Do you need meals provided?
*
Yes
No
Other
Do you require airfare?
*
Yes
No
Other
If yes, what is the cost for airfare?
Will you require parking fees?
*
Yes
No
Other
If yes, what is the cost for parking fees?
Additional Miscellaneous Cost Estimates:
Training Justification:
How will the training benefit the Fire District or enhance your career?
*
Member Signature:
*
Date Submitted
-
Month
-
Day
Year
Date
Submit
Print Form
Station Captain Area
Is this request for:
CBC/College Course or EMT Course.
a Resident Firefighter.
Is this request approved?
Yes, it is approved.
No, it is not approved.
Comments:
Forward for Approval
Resident/CBC/College/EMT Approval Area
Is this request approved?
Yes, it is approved.
No, it is not approved.
Comments:
Forward to:
Training Officer
Forward to Training Officer
Training Captain Area
Is this request approved?
Yes, it is approved.
No, it is not approved.
Comments:
Forward to: (Check Box when ready to forward TRF to District Office to issue travel check.)
District Office
Forward to DO
Should be Empty: