Transcription of Certification Application Form - New Jersey
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Department of Community Affairs Division of Fire Safety Phone: (609) 777-3552 Fax: (609) 341-3469 FIRE INSTRUCTOR Certification Application form 1. SSN Number: Certification Number: 2. Name: Address: City, State, Zip: Telephones Home: Work: _____ _____ (Example: 111111) _____ _____ _____ _____ _____ 3. Certification /Certificate titles: (Check Level 1 or Level 2, and any Certificates) certifications Certificates Instructor Level 2 Drill Ground Instructor Instructor Level 1 Adjunct Instructor Certification REQUIREMENTS FIRE INSTRUCTOR LEVEL 1 A. Be at least 21 years of age; B. Three years experience as a NJ Certified Firefighter 1; C. Satisfactorily complete the 30-hour Fire Instructor 1 course of instruction that meets the requirements of NFPA 1041, Standard for Fire Service Instructor Professional Qualifications, 2002 edition, or an equivalent course of study which meets content specified at 5 (c).
Department of Community Affairs FIRE INSTRUCTOR Division of Fire Safety Phone: (609) 777-3552 Fax: (609) 341-3469 Certification Application Form
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