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Get CT Fire Academy CPAT Form

CFAApplications08. qxd 11/13/07 1 43 PM Page 4 Candidate Physical Ability Test - CPAT form Connecticut Fire Academy 34 Perimeter Road Windsor Locks CT 06096-1069 www. Ct. gov/cfpc Fax 860 654-1889 Your ID Consist of the First 3 Letters of your last name and Last 4 number of your social security number ID Number - 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. ct. gov/cfpc Fax 860 654-1889 Your ID Consist of the First 3 Letters of your last name and Last 4 number of your social security number ID Number - 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. The fee for the test is 150. 00 and is payable by cash check or VISA/MasterCard. You will be notified of your test date and orientation time by mail* There will be two test sessions each day. The morning session is 8 00AM 12 00PM with the afternoon session running from 12 30PM 4 30PM. You will be required to arrive 30 minutes before your scheduled test session begins. 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 Example John Adams - SS 000-00-5555 The new ID will be ADA-5555 Check made payable to CFPC Purchase Order VISA MasterCard Card Card Holder s Name Card Holder s Signature Exp* Date Information such age sex and ancestral heritage are used for statistical purposes only and will not be shared with any employer. Date of Birth / Sex M F Please check one Please check the race s which best applies to you Last Name First Name Home Address American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Pacific Islander City State Phone Home Zip Hispanic or Latino Not Hispanic or Latino DATA PRIVACY WARNING 1. The information provided by you on this form will be used solely and exclusively for providing you Work and like applicants with services. 2. Your social security number is classified as private data* It is used to track your records in regard to Cell personal performance in the CPAT program* 3. The consequence of not furnishing all of the information on this form is that the services may be delayed restricted or withheld. 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. The fee for the test is 150. 00 and is payable by cash check or VISA/MasterCard. You will be notified of your test date and orientation time by mail* There will be two test sessions each day. .

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