Fillable 031919 FCC App (Commonwealth of Massachusetts)

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031919 FCC App (Commonwealth of Massachusetts)

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BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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MARCH 2019
MASSACHUSETTS
FIRECHIEF
CREDENTIAL
(FCC)
COMMONWEALTHOFMASSACHUSETTS
FIRESERVICECOMMISSION
Submit Completed Applications to: DFS.
credentialing@mass.gov
HARD COPY APPLICATIONS WILL NOT BE ACCEPTED
Fire Service Commission
Fire Chief Credential
APPLICATION REQUEST FOR FIRE CHIEF CREDENTIAL
Name _______________________________________________________________________________________________
Department ___________________________Current Position/Rank ____________________ Years in Position _________
Daytime Phone _____________________________Email_____________________________________________________
Work Address________________________________________________________________________________________
City, State, Zip ____________________________________________________________________________________
A COMPLETED APPLICATION INCLUDES:
S
igned Credential Commitment
Letter of Introduction Attached
S
igned Mission and Code of Conduct
F
ormal Education Score Card Formal Education____ points (max 20)
High School Diploma or GED Certificate Attached
College Degree or Certificate Attached
Certifications and Exams Score Card Fire Certs/Exams ____ points (max 20)
Proof of Certifications Attached Other Certs/Exams ____ points (max 15)
Professional Memberships Score Card Membership____ points (max 10)
Proof of Membership Attached
Boards/Commissions/Technical Committees Score Card Boards/Commissions____ points (max 20)
Professional Development Score Card Professional Development____ points (max 50)
Transcripts or Course Certificates Attached
Fire Service/Fire Officer Work Experience Score Card Fire Service ____ points (max 20)
Proof of Appointment Attached
Fire Off
icer ____ points (max 20)
Resume Attach
ed
Professional References
Individual Letters Attached
Organization Chart of Department
All supplemental verification documents should be at the end of the document or in 1 additional separate file.
YOUR ______POINTS
TOTAL REQUIRED 100 POINTS
(DFS Use Only)Denied Approved
Name/Title _________________________________Authorized Signature __________________________ Date_________ Approval # _______________
LMS STUDENT ID
Fire Service Commission
Fire Chief Credential
The Fire Service Commission has identified the need to further enhance the professionalism of Fire Chiefs throughout
the Commonwealth of Massachusetts by the establishment of a uniform credentialing program. The goal of the
program is to ensure a strong degree of accountability and to provide that as many fire chiefs as possible can be
involved in this process. The Credentialing Program sets forth the goals needed for fire chiefs to enhance their
knowledge, skills, and abilities to be fire chiefs in Massachusetts. It establishes a higher degree of professionalism so
that chiefs may be better prepared to serve their department, their community and other organizations. The goal is to
promote the professional development of the fire chief in Massachusetts and to assist these chiefs in their daily
operations, including the management of large-scale incidents. Credentialed participants will be required to renew their
credentials every three years.
The Fire Service Commission, through this program, has attempted to establish occupational education, fire service
related training, and experience criteria relevant to the position of fire chief. This process provides an equal
opportunity for the volunteer, call, or full-time applicant to meet the minimum criteria for achieving the fire chief
credentialing.
This program is not associated with the certification process established by the Massachusetts Fire Training Council.
By participation in this program, an applicant agrees to abide by a Mission Statement and Code of Professional
Conduct.
This credentialing program is solely administered by the Massachusetts Fire Service Commission. Any current Chief of
Department or Chief Officer shall be eligible to apply for credentialing. Additionally, any person holding the rank of
Lieutenant or above shall also be eligible to apply for credentialing. Participation in this program is voluntary and all
eligible personnel are encouraged to participate.
Credential Commitment
I understand that credentialing is subject to the approval of the Fire Service Commission. I will
execute the necessary documents and supply further information as determined by the committee. I
understand that any false statements or misrepresentation submitted in the course of these
proceedings may result in the revocation of any credentialing.
I hereby attest that I am currently an active member of the Massachusetts Fire Service and give permission for
verification of any information provided in this application.
Sign____________________________________________________ Date___________________
Credentialing is valid for 3-years and requires 72 points of continuing education during a consecutive 3-year period.
The Continuing Education component is designed to encourage that new achievement is made during each consecutive
3-year period. This includes remaining current and active with organizations and committees and by keeping your
certifications current, if they require continuing education. The goal is to assist the credentialed Fire Chief in
maintaining a higher level of professionalism within the fire service after initial credentialing.
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Fire Service Commission
Fire Chief Credential
MISSION
Our mission is to provide effective leadership to the fire and emergency services of the Commonwealth.
CODE OF PROFESSIONAL CONDUCT
A key value within the fire and emergency service is strong, ethical and competent leadership. Most professionals abide
by a Code of Ethics or Code of Conduct, which expresses their understanding of what constitutes acceptable behavior.
Abiding by these standards is required for continued recognition as a designated Fire Chief and serves notice to the public
who entrust their confidence in the abilities and integrity of the Fire Chief. It is meant to foster the need for our fire chiefs
to follow these codes in their daily professions as well as in their daily lives.
SECTION 1
We shall be dedicated to the concepts of effective fire protection by responsible fire chiefs and we believe that
professional management is essential to the achievement of this objective. We pledge ourselves to advance the science of
fire service through training courses and other methods to meet the proper requirements of our profession.
SECTION 2
We recognize that the most important function of local fire departments is to serve the best interests of the community.
SECTION 3
We shall be dedicated to the highest ideals of personal character, honor and integrity in all public and personal
relationships in order that fire chiefs may merit the respect and confidence of the community.
SECTION 4
We shall refrain from participating in political activities which may impair our performance as professional
administrators.
SECTION 5
We shall handle all matters in our best judgment so that fairness and impartiality govern our decisions.
SECTION 6
We shall observe all of the provisions of the Constitution of the United States, the laws of the Commonwealth of
Massachusetts and all applicable local statutes.
SECTION 7
We shall make known the risks to be anticipated, should the fire chief’s professional recommendations be disregarded by
others.
SECTION 8
We shall recognize the professional competence and the mutual dependence of all fire chiefs and we pledge cooperation
to those professionals and agencies concerned with the improvement of fire protection.
Sign____________________________________________________ Date___________________
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Fire Service Commission
Fire Chief Credential
FORMAL EDUCATION
High School Diploma or GED Certificate Attached
If you are not able to obtain and attach a copy of your high school diploma, please complete the following
information of the high school you graduated from:
High School Name ________________________________________________________Year of Graduation: ____________
Address _____________________________________________________________________________________
City, State, Zip ______________________________________________________________________________________
College Degree or Certificate Attached
College degrees can be in any subject for credit. No credit for partial completion of degree requirements will be
awarded. All degrees or course work must be from an accredited college or university.
Choose ONLY highest level attained for maximum points.
CRITERIA POINTS
DATE (S)
YOUR POINTS
MAX
20
College Certificate
3
Associates Degree
5
Bachelors Degree
10
Masters Degree
15
Doctorate PhD
20
Fire Service Commission
Fire Chief Credential
CERTIFICATIONS AND EXAMS
Proof of Certifications Attached
Certifications can be issued by Federal, State, NFPA, or other entity recognized by the commission.
Credit for fire examinations will only be awarded if a passing score is achieved. Full point credit assumes
examinations were administered by the Massachusetts Human Resources Division. The commission will consider
examinations conducted by other entities on an individual basis.
Choose ONLY highest level attained for maximum points.
FIRE OFFICER CERTIFICATIONS AND EXAMS
CRITERIA POINTS
DATE
YOUR POINTS
20
5
10
15
20
* The Massachusetts HRD “Chief of Department” or an equivalent exam with a passing score will be considered when requesting the 20
points in the Fire Officer IV or Chief of Department exam.
OTHER CERTIFICATIONS AND EXAMS
CRITERIA POINTS
DATE
YOUR POINTS
15
5
10
15
5
10
15
5
10
15
Fire Prevention Officer I Credential
10
Fire Prevention Officer II Credential
15
10
5
10
5
5
5
5
Fire Service Commission
Fire Chief Credential
PROFESSIONAL MEMBERSHIPS
Membership Cards or a Letter Acknowledging Acceptance of Membership Attached
Only active membership in fire, rescue, or emergency management organizations will be accepted.
Local, county, state, regional, and international organizations are accepted.
Examples of approved memberships include: the International Association of Fire Chiefs, Fire Chiefs Association
of Massachusetts, New England Association of Fire Chiefs, International Association of Arson Investigators,
NFPA and District Organizations.
The applicant must be a member for at least one year prior to the date of application.
CRITERIA POINTS
YOUR POINTS
MAX
10
1 Point Per Year Per Membership
List Dates (YYYY-YYYY)
Fire Service Commission
Fire Chief Credential
BOARDS/COMMISSIONS/TECHNICAL COMMITTEES*
Examples of approved organizations include, but not limited to:
Massachusetts Fire Training Council, Fire Service Commission, Board of Fire Prevention Regulations,
Haz
ardous Materials Advisory Board, 9-1-1 Commission, Massachusetts Homeland Security Councils,
NFPA Technical Committees, etc.
CRITERIA POINTS
YOUR POINTS
MAX
20
4 Points Per Year Per
Board/Commission/Technical Committee
List Dates (YYYY-YYYY)
*Membership on Boards/Commissions Technical Committees to be credited must be based on regional or statewide service, not at the
municipal level and evidence a benefit to the fire service or the public as a whole.
Fire Service Commission
Fire Chief Credential
PROFESSIONAL DEVELOPMENT
ALL trainings included below MUST have been evaluated for credit and appear on the Approved Trainings List
with an Approval #.
I
f there is a training that does not appear on the
Approved Trainings List with credit or you would like to challenge
the awarded credit, you MUST submit a
Training Request for Credit Application and receive an Approval # prior
to including the training below.
Transcripts or Certificates Attached
A
ll attended courses or seminars must be associated with fire service activities, functions or organizations.
Examples of approved organizations include: Accredited colleges or universities (if not counted in a degree for
which you have previously received points), fire attack schools, weekend seminars or workshops, Massachusetts
Firefighting Academy, National Fire Academy, chiefs’ conferences, vendor courses, and other learning
institutions.
APPROVAL
#
TRAINING PROGRAM TITLE
(EXACTLY AS LISTED ON APPROVED LIST)
CRITERIA
POINTS
YOUR
POINTS
MAX
50
List Date(s)
Fire Service Commission
Fire Chief Credential
FIRE SERVICE AND FIRE OFFICER WORK EXPERIENCE
The candidate must be a member in good standing of a Fire Department or Fire District. Time served on fire
departments other than Massachusetts municipal departments will be counted.
I am a member in good standing of a fire department or fire district.
You must provide the commission with proof that you are a member in good standing by attaching one of the
following documents:
• Dated appointment cards
• Fire Department Identification Cards
• A letter from the appointing authority including but not limited to the Town Manager, Town
Administrator, Selectman, Mayor, or Supervisor showing the dates served.
A resume Attached (Must include appointment dates, departments served, and ranks attained).
FIRE SERVICE EXPERIENCE
CRITERIA POINTS
YOUR POINTS
MAX
20
1 Point Per Year Served
List Dates (YYYY-YYYY)
FIRE OFFICER EXPERIENCE
CRITERIA POINTS
YOUR POINTS
MAX
20
2 Point Per Year Served
List Dates (YYYY-YYYY)
Fire Service Commission
Fire Chief Credential
PROFESSIONAL REFERENCES
Individual Letters Signed and Attached
QUALIFYING REFERENCES
• A past supervisor (within 5 years)
• Local, state, or federal officials or department heads
• Emergency services organization officials (public, private, military, etc.)
NON – QUALIFYING REFERENCES
• A subordinate
• A former student
• Friends, neighbors or relatives
REFERENCE #1
Name ______________________________________________________________________________________________
Organization____________________________________Title _______________________ Years in Position _________
Work Address _____________________________________________________________________________________
City, State, Zip ______________________________________________________________________________________
REFERENCE #2
Name ______________________________________________________________________________________________
Organization____________________________________Title _______________________ Years in Position _________
Work Address _____________________________________________________________________________________
City, State, Zip ______________________________________________________________________________________
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031919 FCC App (Commonwealth of Massachusetts)

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Completed 26 July 2020

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