PatRick Environmental, Inc. dba PatRick Corporation

Training Class Request

Training Selected:   Redmond, OR - 08-17-2021 - RT - 130 Refresher
*Name - Last: *First: Middle:
*City: *State: *Zip:
*Cell Phone: *Email Address:
Can you receive Text Messages? Yes Are you located 3 hours or less from our base? Yes

Your Work Experience:

Wildland Fire Experience:
Have you been a Wildland firefighter? Yes
Do you have a copy of your certificate of training? Yes
Who were you trained by?
Last Employment Experience:
*Employer Name:
*Employer Telephone:
*Job Title:
*Start Date: End Date:
*Work Performed:
*Reason for Leaving:
* I hereby authorize PatRick Environmental, Inc. to consult any previous employer.

Wildland Firefighting Disclaimers:

Wildland Firefighting is HARD outdoor work that includes travel. You may be gone 14-30 days at a time. This job includes sleeping outdoors, hiking miles in the forest, and hard physical labor often in steep terrain.
Are you physically fit? Yes
List any reasons you may not be able to do this job?
List qualifications, skills, strengths, and experience that will help you be a wildland firefighter?

* I have read the information, understood, and truthfully answered this Inquiry.
*Digital Signature (type your name): Date: 10/25/2021

*  Indicates required fields