Applicant Information

FDNY Certificate of Fitness C14 ? Renewal Request

Applicant Information

Certificate holders may ONLY request a renewal through the office of EHOS: (i) Six months prior and up to the expiration date shown on certification (ii) Within one year after expiration date on shown on certification (iii) If you are faculty/staff at the college

First Name

M.I.

Last Name

Department Lab Building

Title/Position

Lab Room #

Experience (Years)

Email

Phone/Ext.

NOTE:

If your mailing address has changed since you first applied, please fill in new address:

Street Name

Apt/Unit

City

State

Zip Code

If you do not receive your renewed certification in the mail within 30 ? 60 days after submission, please contact EHOS office.

Compton Goethals 04 | 1617 Amsterdam Ave New York NY 10031 | (212) 650-5080 | ehos@ccny.cuny.edu

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