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Portland Community College
Fire Protection Technology
Certification Application Form
If you don't have an order number, you need to
before submitting your application.
Fire Department or Organization:
Fire Department or Organization Address:
Certification Category and Level
Fire Fighter I *
Fire Fighter II *
HazMat Operations *
For certification prerequisites, please refer to the certification guide for the level of certification for which you are applying.
* Indicates a level that requires verification of SCBA Fit Testing.
Test Site Registration
Location and Date:
Identify the test site and date you would like to test. If you do not have a preference, leave blank.
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
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
Signature of Verification
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)