OEP Professional Development Training - Atlantic County Government

ATLANTIC COUNTY GOVERNMENT
OFFICE OF EMERGENCY PREPAREDNESS
5033 English Creek Avenue • Egg Harbor Township, NJ 08234

- TRAINING APPLICATION -

Name:

Date:


Agency:

Job Title:

Email:

Check box if you would like to be notified by email of any future training courses.

Social Security Number:


Home Phone:		Agency Phone:


:Home Address:

Agency Address:

Do you have any disabilities which would require special consideration during your attendance at one of our training courses? Yes No Please describe and indicate any special considerations on a separate sheet attached to this application. All requests for accommodations must be made thirty (30) days prior to the start of the course.

Course Name:		Date:

Course Name:		Date:

Course Name:		Date:

Please provide any copies of prerequisite course certifications.

Signature of Applicant:		Date:

Agency Representative:		Date:

APPLICATION DOES NOT GUARANTEE ACCEPTANCE.
THOSE ACCEPTED WILL BE NOTIFIED BY E-MAIL.
Mail Applications to:
Atlantic County Office of Emergency Preparedness
Anthony "Tony" Canale Training Center
OEM Operations/Training
5033 English Creek Avenue
Egg Harbor Township, NJ 08231
Or Fax to:
(609)407-6745

Any questions contact Michael J. Bradeis (609) 407-6701 or E-Mail: emer_mgmt@aclink.org.