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

- TRAINING APPLICATION -

Name:  
Date:
 
     
Agency:    
     
Job Title:    
     
Email:    
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?
 
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

John J. Lees  (Jake) (609) 407-6765 or E-Mail:  emer_mgmt@aclink.org.