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2. 

3. 
   Training Request Form

   Please complete this form in its entirety.

4. 

6. Personal Information:
8. First Name*
9. Last Name*
11. Your E-Mail Address:*
13. Choose your Shift:*
    -- Select One --ABCPart-Tme AdministrationFull-Time Administration
17. Training Request Information:
19. Name of Course:*
21. Brief Description of the Course/Rationale of Training Request:*
23. Location of Course:*
24. Have you registered for the course?*

    1. Yes
    2. No
26. Start Date of Training:*
    Start Date of Training:

    Start Date of Training:
27. End Date of Training:*
    End Date of Training:

    End Date of Training:
31. Scheduling Needs:
33. Do you need time off from work for this training?*

    1. Yes
    2. No
34. If you need time off, what date(s) and time(s) are required?*
    If you need time off, what date(s) and time(s) are required? Start Date

    If you need time off, what date(s) and time(s) are required? Start Time

    —

    If you need time off, what date(s) and time(s) are required? End Date

    If you need time off, what date(s) and time(s) are required? End Time
35. Do you have any overdue learning assisgnments?*

    1. Yes
    2. No
36. Do you have any expired certifications or other credentials?*

    1. Yes
    2. No
40. Training Needs & Costs:
42. Do you need a vehicle?*

    1. Yes
    2. No
43. Do you need lodging?*

    1. Yes
    2. No
44. If you need lodging, how many nights are required?*
46. Is there any other associated fee(s), books, etc., required?*

    1. Yes
    2. No
47. If there are other costs involved, please explain:*
51. Electronic Signature Agreement

    Thank you for completing this form.  Please sign below to confirm all data in this form is true to the best of your knowledge.  Please note that this form does not guarantee time off or cost coverage for this course.  Any further questions, please reach out to your respective SMT or Training Division Captain.

    By checking the "I agree" box below, you agree and acknowledge that by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature.

    1. I agree.
53. Electronic Signature
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field