600 College Avenue, Montour Falls, NY 14865 │ 607.535.7136 │www.dhses.ny.gov/ofpc
Fire / Arson Investigation Training Program
Agency Endorsement Affidavit
This form SHALL BE COMPLETED by the sponsoring agency as part of the application process for the following Fire
Investigation Programs AND attached to the standard Academy of Fire Science course application form.
Proposed Arson Course Attendance [check applicable course]
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Intro to Fire Investigation
Fire Investigation
Fire Scene Evidence Course
PART I (To be
completed by applicant)
Name: Last First M.I.
Suffix
Home Address: Number
Street
City/Town
State
Zip
Home Phone#
Birth Date:Month/Day/Year
Studen t Training I D #:
PREREQUISITE VERIFICATION: [PROOF OF COMPLETION MUST ACCOMPANY THIS APPLICATION]
Fire Investigation
Course:
Introduction to Fire Investigation, or Fire Behavior and Arson Awareness AND Principles of Fire Investigation courses or
their equivalents.
Fire Scene Evidence Course:
NYS Fire Investigator Level I Certification or equivalent.
For equivalents please provide copy of course outline and hourly breakdown.
App licants Signature:
Date:
Agency Name:
County:
Business Address: Number/Street
City/Town
State
Zip
Business Phone
Agency Supervisor:
Supervisor Title:
Endorsement A: I hereby signify that the applicant is affiliated with our organization and h
as valid assigned duties in fire investigation
as required, (i.e., Fire, Police, Prosecutor, Insurance Investigator).
___________________________________________________
Agency Sup er visor Signature
Date
______/______/______
Endorsement B: This endorsement must be completed by the
County Fire Investigation Team Supervisor.
If in dou bt as to who i t is, p lease contact your Co unty Fir e Coordinator. Out-of-State resident, con ta ct y our S t ate F ire Marshal.
______________________________________________
__________________________________________________
County Investigation Team Supervisor[print]
conta ct informat ion / phone
I, the undersigned, certify that the applicant is in good standing
with the organization and does perform fire/arson investigations within
the jurisdiction as described.
___________________________________________
County Investigation Team Supervisor[signature]
Date______/_______/_______
Part II [To be completed and signed by endorsing Agency official(s)]
Applicants must have both A and B endorsements with the exception of Paid Fire Departments; Police Agencies and Insurance
SIU which require endorsement A only.
click to sign
signature
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click to sign
signature
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click to sign
signature
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