Form Center

2. Routed to JAC Chair and Operations Chief, CC'd to Supervisor
   CC'd Recipient: This Form is For Awareness Only, No Further Action Required.
4. Please Review the Attached Memo and Ensure all Requirements are Met Before Submitting This Form
   Memo from Sub-JAC Committee
6. Employee Information
8. First Name*
9. Last Name*
11. Requested Course*
13. Agency Providing Course*
14. Location*
16. Start Date*
    Start Date
17. End Date*
    End Date
18. Are You Requesting Shift Coverage?*

    1. Yes
    2. No
20. Tuition Reimbursement Exhausted*
    -- Select One --YesNo
21. Amount Requested
23. If Yes, Dates/Hours of Shift Coverage Requested
25. Please Upload Course Description or Course Flyer
26. Please Upload Receipt/Proof of Payment of Course/Training
28. Your Supervisor *
    -- Select One --Deputy Fire Chief BerensAdministrative Battalion Chief CorteseBattalion Chief GilbertBattalion Chief RhodesBattalion Chief BecerraCaptain AimarCaptain BaraccoCaptain BurgessCaptain CaldwellCaptain ChagonjianCaptain ChamnessCaptain CroweCaptain DavisCaptain GenaroCaptain JonesCaptain KochCaptain LangfordCaptain MortimoreCaptain SquibbCaptain OlivaCaptain UlitinCaptain VoglerGreg FortuneShuree Egloff

    You Supervisor Will Receive This Request

Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field