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Connecticut Fire Academy Candidate Physical Ability Test - CPAT form 2012 Department of Emergency Services and Public Protection 34 Perimeter Road Windsor Locks CT 06096-1069 www. Ct. gov/cfpc Fax 860 654-1889 This Test Takes Place At The CPAT Center In Meriden CT. Directions and test materials will be provided with confirmation before your first orientation session. To register for the test please complete the form below and return it with payment to the Connecticut Fire Academy. Individuals will be assigned in sequential positions as they arrive and register on-site. Please print or type and return with payment to Windsor Locks CT 06096-1069 First Name Home Address Fall Testing Cycle VISA MasterCard Card Card Holder s Name Card Holder s Signature Exp. Date Information about age sex and ancestral heritage is used by the CPAT license grantor only and will not be considered in the evaluation of your application or shared with any prospective employer. The fee for the test is 150. 00 and is payable by cash check or VISA/MasterCard. You will be notified by mail of the dates and times of your orientations practice tests and CPAT test. Except for conditions that prevent testing from being conducted the practice tests and CPAT test will not be rescheduled for any reason* You will be required to arrive 30 minutes before your scheduled test session begins. Date of Birth / Sex M F American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Pacific Islander Please check one 1. Hispanic or Latino 2. Not Hispanic or Latino This information collected for the License Grantor only City Work Purchase Order Last Name Phone Home Spring Testing Cycle Example John Adams - SS 000-00-5555 The new ID will be ADA-5555 State ID Number - Your ID Consist of the First 3 Letters of your last name and Last 4 number of your social security number Zip 2012 CPAT schedule The Connecticut Fire academy offers a spring and a fall testing cycle. Each cycle consists of two orientations two practice tests and the CPAT test. Each testing cycle has an application deadline. The 2012 application deadlines are February 10 2012 for the spring testing cycle and July 27 2012 for the fall testing cycle. Applications received after appropriate deadline will not be accepted* Candidates will receive a packet with the dates and times of their CPAT sessions within two weeks of the application deadline. If you do not receive your packet you must contact the Connecticut Fire Academy to verify your registration within 30 days of the application deadline. The fee for the test is 150. 00 and is payable by cash check or VISA/MasterCard. You will be notified by mail of the dates and times of your orientations practice tests and CPAT test. Except for conditions that prevent testing from being conducted the practice tests and CPAT test will not be rescheduled for any reason* You will be required to arrive 30 minutes before your scheduled test session begins. Date of Birth / Sex M F American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Pacific Islander Please check one 1. Hispanic or Latino 2. Not Hispanic or Latino This information collected for the License Grantor only City Work Purchase Order Last Name Phone Home Spring Testing Cycle Example John Adams - SS 000-00-5555 The new ID will be ADA-5555 State ID Number - Your ID Consist of the First 3 Letters of your last name and Last 4 number of your social security number Zip 2012 CPAT schedule The Connecticut Fire academy offers a spring and a fall testing cycle..

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