"Fire/Arson Investigation Training Program Agency Endorsement Affidavit" - New York

Fire/Arson Investigation Training Program Agency Endorsement Affidavit is a legal document that was released by the New York State Division of Homeland Security & Emergency Services - a government authority operating within New York.

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Fire / Arson Investigation Training Program
Agency Endorsement Affidavit
This form SHALL BE COMPLETED by the sponsoring agency as part of the application process for the following Fire
Investigation Programs AND attached to the standard Academy of Fire Science course application form.
Proposed Arson Course Attendance [check applicable course]
[ ]
Intro to Fire Investigation
Fire Investigation
[ ]
[ ]
Fire Scene Evidence Course
PART I (To be completed by applicant)
Suffix
Name: Last
First
M.I.
Home Address: Number
Street
City/Town
State
Home Phone#
Zip
Birth Date:Month/Day/Year
Student Training ID #:
PREREQUISITE VERIFICATION: [PROOF OF COMPLETION MUST ACCOMPANY THIS APPLICATION]
Fire Investigation Course:
Introduction to Fire Investigation, or Fire Behavior and Arson Awareness AND Principles of Fire Investigation courses or
their equivalents.
Fire Scene Evidence Course:
NYS Fire Investigator Level I Certification or equivalent.
For equivalents please provide copy of course outline and hourly breakdown.
Date:
Applicants Signature:
Part II [To be completed and signed by endorsing Agency official(s)]
Applicants must have both A and B endorsements with the exception of Paid Fire Departments; Police Agencies and Insurance
SIU which require endorsement A only.
Agency Name:
County:
Business Address: Number/Street
City/Town
State
Business Phone
Agency Supervisor:
Supervisor Title:
Endorsement A: I hereby signify that the applicant is affiliated with our organization and has valid assigned duties in fire investigation
as required, (i.e., Fire, Police, Prosecutor, Insurance Investigator).
___________________________________________________
Date
______/______/______
Agency Supervisor Signature
Endorsement B: This endorsement must be completed by the County Fire Investigation Team Supervisor.
If in doubt as to who it is, please contact your County Fire Coordinator. Out-of-State resident, contact your State Fire Marshal.
__________________________________________________
______________________________________________
contact information / phone
County Investigation Team Supervisor[print]
I, the undersigned, certify that the applicant is in good standing with the organization and does perform fire/arson investigations within
the jurisdiction as described.
County Investigation Team Supervisor[signature]
___________________________________________
Date______/_______/_______
600 College Avenue, Montour Falls, NY 14865 │ 607.535.7136 │www.dhses.ny.gov/ofpc
Fire / Arson Investigation Training Program
Agency Endorsement Affidavit
This form SHALL BE COMPLETED by the sponsoring agency as part of the application process for the following Fire
Investigation Programs AND attached to the standard Academy of Fire Science course application form.
Proposed Arson Course Attendance [check applicable course]
[ ]
Intro to Fire Investigation
Fire Investigation
[ ]
[ ]
Fire Scene Evidence Course
PART I (To be completed by applicant)
Suffix
Name: Last
First
M.I.
Home Address: Number
Street
City/Town
State
Home Phone#
Zip
Birth Date:Month/Day/Year
Student Training ID #:
PREREQUISITE VERIFICATION: [PROOF OF COMPLETION MUST ACCOMPANY THIS APPLICATION]
Fire Investigation Course:
Introduction to Fire Investigation, or Fire Behavior and Arson Awareness AND Principles of Fire Investigation courses or
their equivalents.
Fire Scene Evidence Course:
NYS Fire Investigator Level I Certification or equivalent.
For equivalents please provide copy of course outline and hourly breakdown.
Date:
Applicants Signature:
Part II [To be completed and signed by endorsing Agency official(s)]
Applicants must have both A and B endorsements with the exception of Paid Fire Departments; Police Agencies and Insurance
SIU which require endorsement A only.
Agency Name:
County:
Business Address: Number/Street
City/Town
State
Business Phone
Agency Supervisor:
Supervisor Title:
Endorsement A: I hereby signify that the applicant is affiliated with our organization and has valid assigned duties in fire investigation
as required, (i.e., Fire, Police, Prosecutor, Insurance Investigator).
___________________________________________________
Date
______/______/______
Agency Supervisor Signature
Endorsement B: This endorsement must be completed by the County Fire Investigation Team Supervisor.
If in doubt as to who it is, please contact your County Fire Coordinator. Out-of-State resident, contact your State Fire Marshal.
__________________________________________________
______________________________________________
contact information / phone
County Investigation Team Supervisor[print]
I, the undersigned, certify that the applicant is in good standing with the organization and does perform fire/arson investigations within
the jurisdiction as described.
County Investigation Team Supervisor[signature]
___________________________________________
Date______/_______/_______
600 College Avenue, Montour Falls, NY 14865 │ 607.535.7136 │www.dhses.ny.gov/ofpc