Fillable 911 PUBLIC SAFETY TELECOMMUNICATOR RE-EXAM APPLICATION (Florida Department of Health)

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911 PUBLIC SAFETY TELECOMMUNICATOR RE-EXAM APPLICATION (Florida Department of Health)

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BROWSE FLORIDA DEPARTMENT OF HEALTH (FL) FORMS

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911 PUBLIC SAFETY TELECOMMUNICATOR RE-EXAM APPLICATION
DO NOT SEND EXAM FEES WITH THIS APPLICATION.
A. Applicant Information
Attempt # Date/Location of Last Exam
Last Name First Name Middle Initial Date of Birth
Mailing Address City State Zip Code
Phone Number Email Address - *All correspondence will be sent to the email address provided.
B. Employment Status
I am not currently employed as a PST
I am currently employed as a PST by
Training Program Completion
PST Exemption
Firefighter Exemption
Part V: Additional Information / Applicant Signature
________________________________ am the person referred to in this application. All statements
contained herein and in any attachments hereto are true, correct and complete.
Applicant Signature: Date:
Contact Information
Mail applications to:
Florida DOH / 911 PST Program
4052 Bald Cypress Way, Bin A-22
Tallahassee, FL 32399
Phone: 850.245.4440
Email: EMS.Operations@flhealth.gov
Website: www.floridahealth.gov
C. Testing Qualifications
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911 PUBLIC SAFETY TELECOMMUNICATOR RE-EXAM APPLICATION (Florida Department of Health)

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Completed 13 April 2021

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