Portland Community College | Portland, Oregon

Personal Information
Certification Category and Level
Test Site Registration
Special Accommodation
Do you need any special accommodations? If you need special accommodation, please check the box preceding this statement & and you will be contacted by a staff member
Application Verification
Verify: I verify that I have reviewed the certification guidelines as stated in the PCC Fire Protection & Technology Program Certification Policy and Procedure manual and agree to conform to those guidelines. I further verify that all information submitted on this form is accurate.
Fit Test Verification
Verify: I verify by marking this box that I have been fit tested as per OSHA 29 CFR Part 1910.134 within the past 12 months and, if requested, can provide documentation of my fit test. (ONLY REQUIRED FOR: Fire Fighter I, Fire Fighter II, and Haz Mat OPS)