Cpat Online Form Date – Fill Out and Use This PDF

CANDIDATE PSICAL AILIT TEST - CPAT FORM 2013

CONNECTICUT FIRE ACADEMY

DEPARTMENT OF EMERENC SERICES AND PULIC PROTECT

ION

Connectict Fire Acae

3 Perieter Roa insor Locs CT 0010 ctocpc • Fa01

Tis Test Taes Place At Te CPAT Center In Merien	CT Directions an test aterials
ill e proie it coniration eore or ir	st orientation session

To register for the test, please complete the form below and return it with payment to the Connecticut Fire Academy. The fee for the test is $150.00 and is payable by cash, check or VISA/MasterCard. You will be notified by mail of the dates and times of your orientations, practice tests, and CPAT test. Except for conditions that prevent testing from being conducted, the practice tests and CPAT test will not be rescheduled for any reason. You will be required to arrive 30 minutes before your scheduled test session begins. Individuals will be assigned in sequential positions as they arrive and register on-site.

Please print or tpe an retrn it paent to Connectict Fire Acae

3 Perieter Roa insor Locs CT 0010

Caniate Psical Ailit Test 1000

Last Name

First Name

Home Address

City

State	Zip
Phone (Home)
Work
Cell
Applicant’s Signature
 Check made payable to CFPC
 Purchase Order #

			Your ID Consist of the First (3) Letters of your last name
			and Last (4) number of your social security number
ID N	— — — — — — —		Example: John Adams - SS # 000-00-5555
			The new ID # will be ADA
 Spring Testing Cycle		 Fall Testing Cycle

VISA  MasterCard Card # Card Holder’s Name:

Card Holder’s Signature:

Exp. Date:

Information about age, sex, and ancestral heritage is used by the CPAT license grantor only and will not be considered in the evaluation of your application or shared with any prospective employer.

	Date of Birth		/	/	Sex	 M  F Please check one
	Please check the race(s) which best applies to you:
1.		 American Indian or Alaskan Native				Please check the Ethnicity that best applies to you:
2.		 Asian				1.	 Hispanic or Latino
3.		 Black or African American
4.		 White				2.	 Not Hispanic or Latino
5.		 Native Hawaiian or Pacific Islander

(This information collected for the License Grantor only)

2013 CPAT scele

The Connecticut Fire academy offers a spring and a fall testing cycle. Each cycle consists of two orientations, two practice tests, and the CPAT test. Each testing cycle has an application deadline. The 2013 application deadlines are March 7, 2013 for the spring testing cycle and July 25, 2013 for the fall testing cycle. Applications received after appropriate deadline will not be accepted. Candidates will receive a packet with the dates and times of their CPAT sessions within two weeks of the application deadline. If you do not receive your packet you must contact the Connecticut Fire Academy to verify your registration within 30 days of the application deadline.

Retrne cec polic

A $25.00 fee will be assessed to all returned checks (insufficient funds, stop payment, etc). In order to complete your registration after the receipt of a returned check, you must submit cash, money order, or a bank check including the amount of tuition and the returned check fee to the registrar.