Fillable Performance Exam Form - 2021 (City of Huntington Beach)

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Performance Exam Form - 2021 (City of Huntington Beach)

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File type: PDF

U.S.A. forms for City of Huntington Beach

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Huntington Beach Fire Department
Performance Exam Form - 2021
City
Zip Code
PHONE NUMBER:
EMAIL ADDRESS:
Do you have any physical
conditions that may limit your ability to perform the physical exam?
Please input your swim time in the appropriate fields:
100 yd free 500 yd free
2
00
yd free
1,000 yd free
I have signed the waiver on Page 2 of this form:
Initials
Page 1of 2
Last
First
MI
NAME:
ADDRESS:
No
Yes If yes, please explain:
Do y
ou have a valid California Driver's License? No Yes
Please list all related swimming background, training and/or experience:
(i.e. competitive swimming, schools, clubs, Junior Lifeguards , swim times, etc.)
State
Street
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Performance Exam Form - 2021 (City of Huntington Beach)

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Completed 4 February 2022

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