App Form Doc

KCreamer

• Browser built in viewer
• PDF Viewer
• Universal Document Viewer
• Google Docs View
• Google Drive View
• Download Document [pdf]
Not Your Device? Search For Manuals / Datasheets:



File Info : application/pdf, 1 Pages, 141.86KB

Document Document

State Firefighters' and Fire Marshals' Association of Texas
Texas Volunteer Firefighters' and Fire Marshals' Certification Board
PO Box 1709  Manchaca, Texas 78652-1709  Phone: 512.454.3473
For faster processing: e-mail to certification@sffma.org or fax to 512.453.1876

Effective July 1, 2020 all processing requirements must be completed within one year of receipt in the Austin office or application will become void.

1) Fire Department:

Department Information

2) Department's General E-mail:

3) Full Legal Name (including middle name, no initials):

Applicant Information **Fields 3, 5, and 6 are REQUIRED**

4) Name to Appear on Certificate (if different):

5) Last 4 digits of SSN:

6) Birth Date:

7) Applicant's Direct E-mail:

SFFMA OFFICE USE ONLY
DD ID WKS EXP PAYMENT
RECEIVED
CERTIFIED

FIREFIGHTING

 NFPA 1001: Live Fire Prerequisite  NFPA 1001: Firefighter I  NFPA 1001: Firefighter II  NFPA 1051: Wildland Fire Fighting

$25  (see below) $25 ** (See Below) $25
$25

HAZARDOUS MATERIALS

 NFPA 472: HazMat Awareness/Operations

$25

EDUCATIONAL/INSTRUCTIONAL

 NFPA 1035: Public Fire Educator I  NFPA 1035: Public Fire Educator II  NFPA 1041: Instructor I  NFPA 1041: Instructor II  NFPA 1041: Instructor III  Master Instructor

$25 $25 * and ** (See Below) $25 * and ** (See Below) $25 * and ** (See Below) $25 * and ** (See Below) $25

OPERATIONS

 NFPA 1002: Driver/Operator - Pumper

$25

 NFPA 1002: Driver/Operator - Aerial

$25

MANAGEMENT/SUPERVISION
 NFPA 1021: Fire Officer I  NFPA 1021: Fire Officer II

*** (See Below) $25 *** (See Below) $25

 NFPA 1021: Fire Officer III  NFPA 1021: Fire Officer IV  NFPA 1035: Public Information Officer  NFPA 1521: Incident Safety Officer

*** (See Below) $25 *** (See Below) $25
$25 **** (See Below) $25

RESCUE

 NFPA 1006: Rescue Apprentice  NFPA 1006: Confined Space Level I

$25  (See Below) $25

 NFPA 1006: Confined Space Level II  NFPA 1006: Machinery Level I

 (See Below) $25  (See Below) $25

 NFPA 1006: Machinery Level II

 (See Below) $25

 NFPA 1006: Rope Level I

 (See Below) $25

 NFPA 1006: Rope Level II

 (See Below) $25

 NFPA 1006: Structural Collapse Level I

 (See Below) $25

 NFPA 1006: Structural Collapse Level II  (See Below) $25

 NFPA 1006: Surface Water Level I  and  (See Below) $25

 NFPA 1006: Surface Water Level II  NFPA 1006: Swiftwater Level I  NFPA 1006: Swiftwater Level II

 and  (See Below) $25  and  (See Below) $25  and  (See Below) $25

 NFPA 1006: Trench Level I

 (See Below) $25

 NFPA 1006: Trench Level II  NFPA 1006: Vehicle Level I

 (See Below) $25  (See Below) $25

 NFPA 1006: Vehicle Level II

 (See Below) $25

 NFPA 1006: Wilderness Level I

 (See Below) $25

 NFPA 1006: Wilderness Level II

 (See Below) $25

SUPPORT

 NFPA 1061: Telecommunicator I

$25

 NFPA 1061: Telecommunicator II

$25

 NFPA 1584: Support Personnel

$25

PREVENTION/INVESTIGATION
 NFPA 1031: Fire Inspector I  NFPA 1031: Fire Inspector II  NFPA 1031: Plans Examiner I  NFPA 1033: Arson Investigator  NFPA 1033: Fire Investigator

$25 $25 $25 $25 $25

* ** *** **** 
 

Total due for this application form $
YEARS OF SERVICE ________ Prerequisite: Full SFFMA Firefighter I (including exams) Prerequisite: Full SFFMA Firefighter II (including exams) and SFFMA Instructor I Prerequisite: SFFMA Fire Officer I Prerequisite: HazMat Awareness/Operations
Prerequisite: SFFMA Rescue Apprentice Prerequisite: SFFMA Rescue Apprentice and SFFMA Rope Levels I & II

Notice: All applications must either have training documented through:

1) reporting 100% objectives on the website, or

2) course completion certificates attached to this form.

Through the below signature, I attest: 1) the applicant is an active member of the above listed department and that the information contained in this application is true and correct to the best of my knowledge; 2) the applicant has achieved all training required for the certification(s) indicated above and department documented through the SFFMA Online website or by attachment; 3) I will allow 30-60 days from receipt of the application in the Austin Office for processing; and 4) all application processing requirements must be completed within 12 months of receipt in the Austin Office or the application will become void.

Fire Chief Signature

Certification Coordinator Signature

Applicant Signature

Print Name Here Revised 06/20

Print Name Here Stamped, proxy, photocopied, and pencil signatures not accepted

Print Name Here
ALLOW 30-60 DAYS FOR PROCESSING