Town of Lincoln, RI Fire/Rescue Personel only
Name *
Date of Birth *
Rank *
Town of Lincoln, RI
Fire/Rescue Dept.
*
Primary Contact Number *
Email Address *
Fire Certifications
[Level 1, 2, & etc]
*
Rope Rescue Certifications
[Rope 1, 2, &etc]
*
Dive Certifications
[Open water, Dive Rescue, Ice, & etc]
*
Technical Rescue Certifications
[Trench, Confined Space, & etc]
*
Other pertainent information or comments:
NIMS/ICS Training *
Signature *