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(Attachment 2) <br />DESIGNATION OF TRAINING OFFICER <br />Agency Credentialing Guidelines require that the Agency indicate their <br />designation of the EMS Training Officer. <br />Agency Name: ________________________________________________ <br />Date: _____/_____/________ <br />The individual(s) who will provide EMS Training Officer services under the Agency Credentialing <br />Guidelines shall be as follows: <br />I. Agency EMS Training Officer: ______________________________ <br /> Contact Information ______________________________ <br /> ______________________________ <br /> ______________________________ <br /> ______________________________ <br />Preferred Method of Contact: ______________________________ <br />II. Back-Up Training Officer: ______________________________ <br />(Optional) <br />Contact Information ______________________________ <br /> ______________________________ <br /> ______________________________ <br /> ______________________________ <br />Preferred Method of Contact: ______________________________ <br />III. If applicable, please attach EMS Level I Instructor Certificate and any other Instructor certificates <br />IV. Agency Approval <br />Department Chief: ________________________________ ________________ <br /> (Signature) (Date) <br /> ________________________________ <br /> (Printed Name) <br />FOR OCES USE ONLY <br />Received by: ______________________________________ Date: ___________________________ <br />DocuSign Envelope ID: 79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD