Background Investigation: A background investigation will be conducted. Please ensure your application is complete and accurate.

Size: px
Start display at page:

Download "Background Investigation: A background investigation will be conducted. Please ensure your application is complete and accurate."

Transcription

1 Criminal Justice Training Academy 100 College Boulevard Niceville, Florida Office (850) Fax (850) Renée Johnson, Director Dear Applicant: Thank you for your interest in the Basic Recruit Programs at Northwest Florida State College. Attached is an information packet and preliminary application form for the Law Enforcement and Correctional Officer Academies. Please read this cover letter and review the packet thoroughly. Most questions are answered within this packet. Pay particular attention to the enclosed list of Basic Requirements. We cannot accept applicants into the Academy that have been convicted of a felony, a misdemeanor involving perjury or false statement, domestic violence related offenses, or moral character violations as defined by the Florida Department of Law Enforcement s (FDLE) Criminal Justice Standards and Training Commission (CJSTC). If you are unsure of your eligibility, please see attachment in this packet and/or consult a member of the Training Center staff. The entire application must be filled out. Incomplete applications will not be considered for admittance to either recruit program. Your application must be printed or typed and be legible only black and blue ink are acceptable. Your application and all other paperwork must be returned in person to the Public Safety Division office located in Building F on the Niceville Campus. At that time your fingerprints will be captured for submittal to FDLE and the Federal Bureau of Investigations (FBI). Seating preferences are assigned on a first come, first serve basis; therefore, it is important to submit your application in a timely manner. Applications will only be kept on file for twelve (12) months. Medical Clearance: You must submit a completed FDLE Physical Fitness Assessment form (CJSTC-75B), an FDLE Chemical Agent Exposure Training Evaluation form (CJSTC-6A), and an NWF State College Physical Requirements/Limitations form all signed by a doctor, physician s assistant or nurse practitioner. No one will be permitted to participate in the academy without these forms being completed and on file in the Public Safety Division office. Background Investigation: A background investigation will be conducted. Please ensure your application is complete and accurate. Portions of the packet require notary services. Notary service is available in the Public Safety Division offices; however, you must call in advance for an appointment. Approximately three weeks prior to the start of the academy a letter will be mailed to all students who have submitted completed applications. The letter will inform you of the date/time/location of academy orientation (generally seven days prior to the start of the academy). You must contact our office upon receipt of the letter and confirm your continued interest in attending the academy. All students are required to attend academy orientation. During orientation you will receive additional information about the academy, to include how and when to register for courses, academy policies and procedures, and more. Again, YOU ARE REQUIRED TO ATTEND ORIENTATION. Note: If you intend on attending the academy, it would be a good idea to go ahead and apply for financial aid. Please feel free to contact us at if you have any questions or if we can be of assistance. Phyllis Davis Instructional Support Specialist, Steven Hough Training Coordinator, Jeff McGill-Training Coordinator, Renée Johnson Training Director, 1

2 Law Enforcement/Corrections Officer Basic Recruit Training Program Requirements Under Florida Department of Law Enforcement (FDLE) rules and Florida Statutes, in order to qualify for certification as a law enforcement/corrections officer, applicants must meet the following requirements: Be at least 19 years of age Be a United States citizen Have a high school diploma or a GED certificate No convictions of any felony or a misdemeanor involving perjury or false statement Never received a dishonorable discharge from any of the Armed Forces Have good moral character Complete an application to Northwest Florida State College Pass Florida Basic Abilities Test (FBAT) If new student, must attend academy orientation Passed the Medical Exam required to be accepted into Academy Agree to be fingerprinted by the training center school. Successful completion of background investigation These are the minimum qualifications set by the State of Florida for taking the State Certification Exam and receiving certification. A candidate who has a number of felony arrests without a conviction and/or an extensive record of traffic violations showing a disregard for the law, may be eligible to take the State Exam, but will have little or no chance of being employed by any law enforcement or corrections agency. In addition, Federal Law prohibits any individual who has been convicted of a domestic violence charge (felony or misdemeanor) from carrying a firearm. This law prohibits an individual with such a conviction from becoming a law enforcement/corrections officer. Criminal Justice agencies in Florida are free to set their own additional requirements on candidates for employment such as physical requirements, drug use, and criminal history. Applicants must meet the standards of that particular agency they apply for. Passing the Basic Recruit Training Program does not guarantee employment with a Criminal Justice agency. Under Florida Statutes Chapter 943, the certification process begins with a candidate successfully completing a Criminal Justice Standards and Training Commission (CJSTC) Basic Recruit Training Program. The candidate receives a Certificate of Completion upon graduation and applies to sit for the State Officer Certification Exam (SOCE). Upon successful completion of the SOCE, the candidate must become employed with a law enforcement or corrections agency. The candidate can then apply to CJSTC for certification. The candidate has four years from the beginning of the Basic Recruit Training Program to fulfill these requirements and become certified. 2

3 Basic Recruit Academy List of Moral Character offenses which may disqualify you from employment cited by sections of the Florida Statutes False oath before a notary Fleeing/attempting to elude an officer Public assistance fraud Assault (3-7, 10) Explosives violations (2) Culpable negligence Battery Improper exhibition of a weapon/firearm (1) Carrying a concealed weapon Poss/Sale of firearm w/ altered serial # Furnishing weapons to minors Renting space for prostitution or lewdness Willful failure to report gunshot wounds Exposure of sex organs Failure to report sexual battery Criminal mischief Prostitution/lascivious (d) Petit theft Unnatural/lascivious act Possession of altered property False fire alarms Theft of utilities/cable services Trespass to structure or conveyance Distribution of fictitious court documents Theft of trade secrets Sale of counterfeit controlled substance Removing/altering property id marks Negligent treatment of children False report of a crime Fighting/baiting animals Fraudulent urine drug test Prescription fraud (2-3) Child abuse Stop payment of check w/ intent to defraud Persistent nonsupport of child/spouse Perjury not in official proceedings (1)(b) Mfg. of counterfeit controlled sub Resisting an officer without violence (2-4) Passing worthless checks Aiding inmates escape from training school False report to law enforcement Pornography offenses Refusal to serve arrest warrant Transport of obscenity into state False imprisonment of an officer Loitering or prowling Publishing name and address of LE officer Unlawful assemblies (2) Retail display of obscenity to minors Burning a cross on another s property Wholesale promotion of obscenity (2) Witness tampering Affrays and riots (7)a False reports concerning use of force Burning a cross in a public place (3) Malicious battery on a prison inmate Accept UA compensation from inmate (1-2) Controlled substance violations 3

4 4

5 5

6 Basic Recruit Academy Application Date: Please ensure all questions are answered completely, accurately and truthfully. If any item does not pertain to you, answer N/A (not applicable). Keep in mind all information will be checked and verified. Misstatements, falsifications or omissions may delay and/or terminate entrance into the Academy. Last Name First Name Middle Name Maiden Name Social Security #: List any other names you may have used. Include former names, aliases, and/or nicknames. Address: City and State: County: Zip: Home Phone: Work Phone: Cell Phone: Address: Emergency Contact: Relationship: Phone: Are you a U.S. Citizen? Yes No Date of Birth: State of Birth: Birth Country: Do you possess a valid driver s license? Yes No State Issued: Driver s License #: Expiration Date: Gender: Male Female Race: Eye Color: Hair Color: Education Level: High School Graduate GED Some College 2 year degree Bachelor Degree Master Degree Other: List number of credits earned: Applicants are chosen on a first come, first serve basis. 6

7 Are you a certified law enforcement or corrections officer? If yes, what state? Have you ever been rejected by any law enforcement agency or law enforcement training school? Yes No If yes, explain: Have you ever been in the military? Yes No If yes, Active or Reserves? List all separations or discharges form the military. (Honorable, Dishonorable, Honorable Conditions, Medical, etc) Also include a copy of your DD-214(Member Copy 4): Arrest History: If you answer yes to any of the following, please provide an explanation in the area below. Have you ever been arrested, charged, or issued a notice or summons to appear for any criminal violation, as an adult or juvenile? Yes No Have you ever received a ticket or been charged with a traffic violation? (Excluding parking tickets) Yes No Have you ever been detained by any law enforcement officer for investigative purposes or to your knowledge have you ever been the subject or a suspect in any criminal investigation? Yes No Explanation: 7

8 Criminal Justice Training Center AGREEMENT TO OBEY INSTRUCTIONS, RELEASE, ASSUMPTION OF RISK AND AGREEMENT TO HOLD HARMLESS I am aware that participating in the Northwest Florida State College Basic Recruit Program can be dangerous in nature involving many risks of injury. I understand that the dangers and risks of participating in the program include, but are not limited to, death, serious neck and spinal injuries, injuries to virtually all bones, joints, ligaments, muscles, tendons, and other aspects of the muscular skeletal system, serious injury to virtually all internal organs, and serious injury or impairment to other aspects of the body, general health and wellbeing. I understand that the dangers and risks of participating may result not only in injury, but also in a serious impairment of my future abilities to earn a living, engage in other business, social and recreational activities, and generally to enjoy life. I attest and affirm that I am physically fit and able to participate in the activities and I have not been advised or informed by anyone in the contrary. I will immediately bring to the attention of Northwest Florida State College and the Criminal Justice Training Center Staff, any medical or other problems that may affect my health and/or fitness and ability to participate in any activity related to the program. Because of the dangers of participating in the program, I recognize the importance of following the instructions regarding the activities and agree to obey all such instructions. In consideration of the Northwest Florida State College Board of Directors and other designated organizations for allowing me to use their facilities, I assume all risks associated with participation and release and agree to hold harmless the Board of Directors of Northwest Florida State College, their employees, agents, representatives, and volunteers from any and all liability, actions, causes of actions, debts, claims, or demands of any kind and nature whatsoever including any medical treatment and expenses incurred as a result of any injury that I might receive while participating in the above activity related to the program. The terms hereof shall serve as a release, assumption of risk, and hold harmless agreement not only for ourselves, but also for our heirs, estates, executors, successors, administrators, assigns, and for all members of our family. (Signature of Student) (Date) (Signature of Witness) (Date) 8

9 Criminal Justice Training Center I hereby authorize Northwest Florida State College and, in particular, the Criminal Justice Training Center to release any and all records, test results, evaluations, and any information of a privileged nature, which may have been accumulated or compiled by virtue of my attendance, to the Florida Department of Law Enforcement, Division of Criminal Justice Standards and Training. Also to any state, county, or local law enforcement or corrections agency that has an official need for such records. I hereby release you, your organization, or others from any liability or damage, which may result from furnishing the information requested above. I have read and understand the above listed statement and authorize the release of my records. Date:, 20. Students Name: (Last name) (First name) (M.I.) Applicant s Signature Date SSN: Address City State Zip Code 9

10 Criminal Justice Training Center Statement of Military Service I have never served with any branch of the Armed Forces of the United States of America. - Or - I am currently an active member of the Armed Forces of the United States of America, the Armed Forces reserve of the United States of America, or the National Guard. - Or - I have served, but I am no longer serving, as a member of any branch of the Armed Forces of the United States of America (attach a copy of DD-214, member copy 4). This document shall constitute an official statement within the purview of Section of the Florida State Statutes, and is subject to verification by the Criminal Justice Training Center and/or the Florida Criminal Justice Standards and Training Commission. (Applicant s signature) Sworn to and subscribed by me this day of, 20 A.D. Notary Public, State of Florida My commission expires: 10

11 Criminal Justice Training Center Criminal History Statement (Please read carefully before signing) I fully understand that in order to qualify as a candidate for participation in the course of study for Law Enforcement Officer or Correctional Officer, I must comply with the Rules and Regulations of the Florida Department of Law Enforcement Criminal Justice Standards and Training Commission. I understand that if I have a sealed or expunged record that I may not be eligible for employment or appointment as a Criminal Justice Officer. I therefore attest to the following: 1. I have not been convicted of any felony. I have not been convicted of a misdemeanor involving perjury or false statement, nor have I received a dishonorable discharge from any of the Armed Forces of the United States of America; and 2. I have not, after July 1, 1981, pled guilty or nolo contendere or have been found guilty of any felony, or any misdemeanor involving perjury or false statement, notwithstanding suspension of sentence or withholding of adjudication. 3. I have not been convicted of a misdemeanor crime involving domestic violence, including the use, attempted or threatened use of physical force, as one of the defined parties in the Omnibus Consolidated Appropriations Act of 1997, a part of which is an amendment to the Gun Control Act of I am of good moral character as defined in Florida Administrative Code 11B In the State of Florida, County of, before me personally came, who being duly sworn deposes and says: I hereby certify that to the best of my knowledge and belief, the information that I have entered on this form is true. (Applicant s signature) Sworn to and subscribed by me this day of, 20 A.D. Notary Public, State of Florida My commission expires: 11

12 Release and Indemnity Agreement In consideration of being permitted to utilize the firing range and driving range located at Northwest Florida State College (the Institution ), the undersigned (the Releasor ) hereby releases, waives, discharges and covenants not to sue the State of Florida, Northwest Florida State College or any of their employees, instructors, or associate-instructors. Also to release them from all liability to the Releasor, for all loss, damage, liability and cost on account of injury to person or property, whether caused by the negligence, intentional conduct or omission of the Institution, or anyone else, while the Releasor is at the Institution. Releasor agrees to indemnify the Institution from any loss, liability, damage or cost the Institution may incur due to the activities of Releasor at the Institution, whether caused by the negligence, intentional conduct or omissions of the Releasor. Releasor expressly agrees that this release, waiver, and indemnity agreements is intended to be as broad and inclusive as permitted by the laws of the State of Florida and that if any portion of the agreement is held invalid, it is agreed that the balance, notwithstanding, continue in full legal force and effect. Releasor further states that he/she has carefully read the above release and knows the contents of the release and signs this release, as the releasor s own free act. Dated this day of, 20. Releasor Signature Print name of Releasor Print address of Releasor 12

13 Florida Department of Law Enforcement PHYSICAL FITNESS ASSESSMENT Incorporated by Reference in Rule 11B (11)(c)12., F.A.C. CJSTC 75B 1. Applicant s Name: 2. Applicant s Address: Last First MI 3. Enter Last Four Digits of Social Security Number: 4. Training School: 5. The Applicant Is Requesting Admission Into a Basic Recruit Training Program for One of the Following Disciplines: Law Enforcement Correctional Correctional Probation 6. Student Participation in Basic Recruit Training Program Activities. A student enrolled in a basic recruit training program (BRTP) is required to participate in the following activities: A. Defensive tactics and firearms high-liability training is a component of the curriculum mandated by the Criminal Justice Standards and Training Commission. Firearms training requires firing a handgun and long gun creating exposure to lead. Defensive tactics training requires sustained physical exertion and chemical agent contamination to the chemicals oleo-resin capsicum (OC) and/or orthochlorobenzal-malonotrite (CS). B. Physical Fitness Conditioning and Physical Fitness Testing: A BRTP student shall participate in physical fitness conditioning and a fitness test and includes the following measures: Vertical Jump One Minute Sit Ups 300 Meter Run Maximum Push Ups 1.5 Mile Run/Walk C. The training center director has attached the training schools physical fitness conditioning program: Yes **********TO BE COMPLETED BY THE APPLICANT********* 7. Medical Conditions Regarding OC/CS Contamination. A BRTP student should be aware of the following personal considerations that may restrict participation in the chemical agent contamination of the BRTP and could possibly be aggravated to a severe degree during the contamination: Recent eye surgery, heart problems, panic disorder or stress, respiratory disorder, emphysema (loss of elasticity/thinning of lung tissues), bronchial asthma, x-ray evidence of pneumoconiosis (black lung), evidence of reduced pulmonary (lung) function, chronic obstructive pulmonary disease, coronary (heart) artery disease, cerebral (brain) blood vessel disease, severe or progressive hypertension (high blood pressure), epilepsy, grand mal or petite mal (seizures), pernicious anemia (severe reduction in red blood cells), diabetes (any form), pueumomediastinum gap (air in the sac surrounding lungs), history of skin allergies, or any condition for which the student is presently taking medication. 8. BRTP Student Certification. I certify that I have reviewed the above information and I do or do not have any medical restrictions that would prevent me from participating in the basic recruit training program activities outlined in item numbers 6, 6A, and 6B above. 9. Student s Printed Name: 10. Student s Signature: Date: 11. Prior Exposure to OC or CS. For a student who has had prior chemical agent exposure that includes chemical agent contamination and working through the effects of chemical agent contamination in a training environment, please attach the supporting documentation of prior exposure and check one of the following boxes: I certify that I have OR I have not been exposed to oleo-resin capsicum (OC) and/or orthochlorobenzal-malononitrile (CS) in the manner described in item number 11 above. **********TO BE COMPLETED BY THE EXAMINING PHYSICIAN********* 12. Physician Attestment. The above applicant is seeking entry into a law enforcement, correctional, or correctional probation basic recruit training program. Rule 11B (11)(c)12., F.A.C., requires a complete physical examination at a level of specificity sufficient to determine whether there are any medical or physiological restrictions that would prevent the applicant from performing the required activities described in items 6, 6A, and 6B above. Disabilities, impairment, or limitations identified by the examination that would prevent the applicant from performing the required activities should be reported to the training school indicated in item number 4 above. I hereby attest that I have examined the above named applicant and find him or her CAPABLE of participating in the basic recruit training program activities indicated in item numbers 6, 6A, and 6B above. I hereby attest that I have examined the above named applicant and find him or her NOT CAPABLE of participating in the basic recruit training program activities indicated in item numbers 6, 6A, and 6B above 13. Physician, Certified Advanced Registered Printed Name Examination Date Nurse Practitioner, or Physician Assistant s Signature Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant s License Number Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant s Professional Address Licensing State **********TO BE COMPLETED BY THE TRAINING CENTER DIRECTOR OR DESIGNEE********* 16. Training Center Director or Designee s Printed Name: Training Center Director or Designee s Signature: Date: Training School: Original Agency: Copy 1 of 2 Applicant: Copy Created 11/8/2007

14 INSTRUCTIONS FOR COMPLETING FORM CJSTC-75B A basic recruit student approved to enter a basic recruit training program (BRTP) shall review and complete form CJSTC-75B to indicate the presence of any medical conditions that may prevent participation in the Physical Fitness Program and Chemical Agent Contamination of the BRTP. A copy of the Physical Fitness Program for law enforcement, correctional, or correctional probation discipline shall be attached to this form for the student to review. 1. Applicant s Name. Enter the applicant s last name, first name, and middle initial. 2. Applicant s Address. Enter the applicant s current address, city, state, and zip code. 3. Applicant s Social Security Number. Enter the last four digits of the applicant s social security number as in this example: Training School Name. Enter the name of the Commission-certified criminal justice training school where the applicant is enrolled. 5. Basic Recruit Training Program Discipline. Place a check mark in one of the box(es) for the law enforcement, correctional, or correctional probation discipline for which the applicant is requesting admission. 6. Student Participation in Basic Recruit Training Program Activities. Defensive Tactics (includes chemical agent contamination), Firearms, and Physical Fitness Conditioning and Physical Fitness Testing: High-liability training in defensive tactics, firearms, and chemical agent contamination is a component of the curriculum mandated by the Criminal Justice Standards and Training Commission and participation in the activities is a requirement for successfully completing a BRTP. There is no pass or fail at this time. The test results for each of the five required tests will be recorded on the Academy Physical Fitness Standards Report, form CJSTC-67A as I if the student did not perform the test component or D if the student was dismissed from the basic recruit training program. A. Defensive Tactics and Firearms Training. Firearms training requires firing a handgun and long gun creating exposure to lead. Defensive tactics training requires sustained physical exertion and chemical agent contamination to the chemicals oleo-resin capsicum (OC) and/or orthochlorobenzal-malonotrite (CS). B. Physical Fitness Conditioning and Physical Fitness Testing. The Physical Fitness Test includes the following measures and are defined as follows: Vertical Jump. This measures leg power by measuring how high a person jumps. One Minute Sit Ups. This measures abdominal, or trunk, muscular endurance. While lying on his or her back, the student will be given one minute to do as many bent-leg sit ups as possible. 300 Meter Run. This measures anaerobic power, or the ability to make an intense burst of effort for a short time period or distance. This component consists of sprinting 300 meters as fast as possible. Maximum Push Ups. This measures the muscular endurance of the upper body. This component consists of doing as many push ups as possible until muscular failure. Males are required to perform the standard push-up and females have the option to perform the standard or modified push-up. 1.5 Mile Run/Walk. This measures aerobic power or cardiovascular endurance (stamina over time). To complete this component, the student runs or walks a distance of 1.5 miles as fast as possible. C. A physical fitness conditioning program developed by the training school shall be attached to form CJSTC-75B prior to the student s examination by a physician, certified advanced registered nurse practitioner, or the physician s assistant. 7. Medical Conditions Regarding Chemical Agent Contamination. The student shall review the listed medical conditions and list other conditions that may restrict him or her from participating in Chemical Agent Contamination to the chemicals oleo-resin capsicum (OC) and/or orthochlorobenzal-malonotrite (CS). 8. Basic Recruit Training Program Activities Certification. The student shall check the appropriate box to indicate if he or she does or does not have a medical condition that would restrict participation in the BRTP activities indicated in item numbers 6, 6A, and 6B of this form. 9. Student s Printed Name. The student shall print his or her first name, last name, and middle initial. 10. Student s Signature and Date. The student shall provide a signature and date to verify the information provided by the student is true and correct. 11. Prior Exposure to Chemical Agent Contamination. The student shall Indicate in the appropriate box if he or she has been previously exposed to chemical agent contamination to the chemicals oleo-resin capsicum (OC) and/or orthochlorobenzal-malonotrite (CS), and shall attach supporting documentation of such contamination. 12. Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant s Attestment. The physician shall check the appropriate box to indicate if the student is capable or not capable of participating in the BRTP activities indicated in item numbers 6, 6A, and 6B of this form. 13. Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant s Signature, Printed Name, and Examination Date. The physician shall complete this item to verify his or her attestment to item number 12 of this form. 14. Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant s License Number and Licensing State. The physician shall complete this item to verify his or her valid license number and licensing state. 15. Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant s Professional Address. The physician shall print his or her complete professional address. 16. Training Center Director or Designee s Printed Name, Signature and Date. The training center director or designee who signs this form shall print his or her legal first and last name. The training center director or designee shall sign and date this form. FORM CJSTC-75B Page 2 of 2

15 Material Safety Data Sheet May be used to comply with OSHA's Hazard Communication Standard, 29CFR Standard must be consulted for specific requirements. SECTION 1 - Manufacturer's Name Defense Technology / Federal Laboratories Address Emergency Telephone No. Postal Box 248 (800) City, State, and ZIP Signature of Person Responsible for Preparation (Optional) SECTION 2 - HAZARDOUS INGREDIENTS / IDENTITY Other Information Calls Casper, Wyoming (877) Date Prepared 11/01/01 PEPPER MACE QUICK IDENTIFIER Common Name: (used on label and list) MK4 5.5% Pepper Mace Stream Hazardous Component(s) (chemical & common name(s)) OSHA ACGIH Other Exposure % CAS PEL TLV Limits (optional) NO. Capsaicin NG ppm NG ppm D-Limonene NG ppm NG ppm Secondary Butanol 100 ppm 100 ppm Propylene Glycol NG ppm NG ppm Dipropylene Glycol Monomethyl Ether 100* ppm 100* ppm Note: *Skin SECTION 3 - PHYSICAL & CHEMICAL CHARACTERISTICS Boiling Specific Point Gravity (H2O = 1) Solubility in Water Slight Appearance and Odor Vapor Pressure (mm Hg) 211 F 370 F NG Vapor Density (Air = 1) SECTION 4 - FIRE & EXPLOSION DATA Reactivity in Water Melting Point Flash Method Flammable Limits LEL UEL Point 110 F Used Closed Cup in Air % by Volume Lower Upper Auto-lgnition Extinguisher Temperature Media Special Fire Fighting Procedures NG Dark Brown Liquid, Aromatic Odor Cool containers if exposed to fire or high heat. Use dry chemical, CO2, or water spray. NG Unusual Fire and Explosion Hazards Product packaged in aerosol form may cause containers to burst when exposed to extreme heat.

16 SECTION 5 - PHYSICAL HAZARDS (REACTIVITY DATA) Stability Unstable Conditions Stable to Avoid Incompatibility (Materials to Avoid) Avoid exposure to extreme heat. PEPPER MACE QUICK IDENTIFIER Common Name: (used on label and list) MK4 5.5% Pepper Mace Stream Hazardous Decomposition Products Hazardous thermal decomposition products may form such as Carbon Monoxide, Carbon Dioxide and other toxic and corrosive gases. Hazardous May Occur Conditions Polymerization Will Not Occur to Avoid SECTION 6 - HEALTH HAZARDS 1. Acute 2. Chronic See Signs and Symptoms Signs and Symptoms of Exposure Pungent fumes may be emitted on exposure to temperatures above 175 F. May cause superficial keratitis, conjunctivitis and irritation to the stomach and digestive system. Medical Conditions Generally Dermititis. Aggravated by Exposure Chemical Listed as Carcinogen or Potential Carcinogen Emergency and First Aid Procedures ROUTES OF ENTRY National Toxicology Yes I.A.R.C. Yes OSHA Yes Program No Monographs No No Remove to fresh air. If breathing is difficult, administer oxygen. If breathing has stopped, administer CPR. Flush eyes with cool water for at least 15 minutes. Wash with cool water and soap. Drink a glass of water and induce vomiting. 1. Inhalation Burning sensation, irritation and nausea. 2. Eyes 3. Skin 4. Ingestion Burning sensation and irritation. Liquid and vapors can cause irritation. SECTION 7 - SPECIAL PRECAUTIONS AND SPILL / LEAK PROCEDURES Precautions to be Taken in Handling and Storage Liquid can cause nausea and a burning sensation. Packaged product is under pressure. Do not puncture, incinerate or store at temperature above 130 F. Other Precautions Irritating to eyes, nose and skin. Avoid inhaling vapors and contact with skin. Steps to be Taken in Case Material is Released or Spilled Extinguish all flames then soak up material in absorbent material and shovel into waste container. Waste Disposal Methods ( Consult Federal, State, and Local Regulations ) Dispose of in accordance with local, state and federal regulations. SECTION 8 - SPECIAL PROTECTION INFORMATION / CONTROL MEASURES Respiratory Protection ( Specify Type ) Ventilation Protective Gloves Other Protective Clothing or Equipment Work/Hygienic Practices Use chemical respirator, NIOSH approved. Local Mechanical Exhaust ( General ) Use solvent-resistant rubber gloves Use solvent-resistant type with full jacket. Eye Protection Special Yes Yes Yes No No Use chemical-resistant goggles. Other Avoid absorption of product on clothing. If absorbed in clothing, remove and launder at once. IMPORTANT Do not leave any blank spaces. If required information is unavailable, unknown, or does not apply, so indicate.

17 Criminal Justice Training Center I am aware of the physical requirements listed below and I have no physical limitations which would preclude my participation in the high-liability training areas of the Northwest Florida State College Basic Recruit Program. Applicant s Name: Social Security #: Applicant s Signature: Date: Basic Recruit Program students are required to perform in the subject areas of Physical Training, Defensive Tactics, Firearms Training, and Medical First Aid as indicated below. Please initial the appropriate block which identifies the student s ability to participate in each of the areas listed. Arrest Techniques: Requires the individual to bend at waist and knees (squat and kneel). Student must have full range of motion of both arms and manipulative dexterity of the hands to properly handcuff and control an individual. Self-Defense: Requires the individual to have joint structures which are completely flexible and free of anomalies. The individual will be required to kick, punch, and block or parry blows. Flexibility Exercise: Requires the individual to participate in a variety of exercises focusing on all major muscle groups. The exercises consist of active stretching of the muscle groups through ballistic and non-ballistic movements. Physical Conditioning: Requires the individual to participate in a variety of physical activities involving strength, flexibility, and cardiovascular endurance. This may consist of, but not limited to, push-ups, pull-ups, sit-ups, leg lifts, and 1 ½ mile run. Cardiopulmonary Resuscitation: Requires the individual to possess enough physical strength and endurance to compress the chest of an adult 1 ½ to 2 at a rate of 80 compressions per minute for five minutes. Must possess the vital capacity to inflate the lungs of a training manikin with a minimum of 0.8 liters. In addition, must have the strength to roll a 150 pound manikin to a proper position to administer back blows and abdominal thrusts. Firearms Training: Requires the individual to be capable of 8 10 hour blocks of training in firearms, outdoors in prevailing weather conditions. Training may necessitate carrying 3 x 4 targets and frames, shooting up to 300 rounds of handgun ammunition (per training block), up to 50 rounds of shotgun ammunition per training block, and being in direct contact with chemical agents, to wit: Chloracetophenone gas (a.k.a. CN gas), Orthochlorobenzylidene Malononitrile (a.k.a. CS gas, or tear gas) gas, Oleoresin Capsicum (a.k.a., pepper spray), and smoke. Training may also require running, jumping, kneeling, rolling, squatting, crawling, and shooting during a timed, highly stressful reactionary course. Yes No Physician s Signature: Date: Physician s Name (printed): Physician s License Number and State of Licensure: Physician s Comments:

WELCOME TO. Must have been honorably discharged from military. (If applicable) Must be able to comply with rigorous attendance requirements.

WELCOME TO. Must have been honorably discharged from military. (If applicable) Must be able to comply with rigorous attendance requirements. WELCOME TO FLORIDA GATEWAY COLLEGE PUBLIC SERVICE TRAINING CENTER In today s fast paced, ever changing society, the need for knowledgeable, dedicated criminal justice professionals is vital. A career in

More information

Criminal Justice Institute

Criminal Justice Institute May 22, 2014 Dear Student: Thank you for your interest in obtaining your Florida certification as a law enforcement or correctional officer. The Equivalency-of-Training process enables one to become exempt

More information

Criminal Justice Selection Center

Criminal Justice Selection Center Send all mail to: Gulf Coast Criminal Justice Selection Center http://www.gulfcoast.edu/north_bay/selection Our physical location: Criminal Justice Selection Center North Bay Campus, Abbott Building 5230

More information

MATERIAL SAFETY DATA SHEET "LIQUID FIRE" DRAIN LINE OPENER 09/2007 PHYSICAL/CHEMICAL CHARACTERISTICS:

MATERIAL SAFETY DATA SHEET LIQUID FIRE DRAIN LINE OPENER 09/2007 PHYSICAL/CHEMICAL CHARACTERISTICS: 09/2007 MATERIAL SAFETY DATA SHEET "LIQUID FIRE" DRAIN LINE OPENER MANUFACTURER'S NAME: AMAZING PRODUCTS, INC. P.O. BOX 14226 LOUISVILLE, KY 40214 PHONE: 502-361-3655 FAX: 502-361-1810 E-MAIL: amazingp@bellsouth.net

More information

MATERIAL SAFETY DATA SHEET DATE: 2009, revised July 2011 PRODUCT NAME: BOSTON BRAKE & PARTS CLEANER PRODUCT CODE: 78200

MATERIAL SAFETY DATA SHEET DATE: 2009, revised July 2011 PRODUCT NAME: BOSTON BRAKE & PARTS CLEANER PRODUCT CODE: 78200 MATERIAL SAFETY DATA SHEET DATE: 2009, revised July 2011 PRODUCT NAME: BOSTON BRAKE & PARTS CLEANER PRODUCT CODE: 78200 SUPPLIER S NAME : SECTION I SUPPLIER IDENTIFICATION CAMPBELLS WHOLESALE PTY LTD ADDRESS

More information

MATERIAL SAFETY DATA SHEET WWF -20 1 of 5 1 Gal Xtreme Blue -20 Windshield Washer Fluid. 121 Landmark Drive Greensboro, NC 27409

MATERIAL SAFETY DATA SHEET WWF -20 1 of 5 1 Gal Xtreme Blue -20 Windshield Washer Fluid. 121 Landmark Drive Greensboro, NC 27409 WWF -20 1 of 5 = SECTION I - COMPOSITION / INFORMATION ON MATERIALS = VAPOR PRESSURE WEIGHT REPORTABLE COMPONENTS CAS NUMBER mm Hg @ TEMP PERCENT -------------------------------------------------------------------------------------------

More information

22 APR 2010 300088 MATERIAL SAFETY DATA SHEET. PHENOLPHTHALEIN INDICATOR SOLUTION # HR - 2497. Part#: N/A

22 APR 2010 <MSDS_ID>300088</MSDS_ID> MATERIAL SAFETY DATA SHEET. <Product> PHENOLPHTHALEIN INDICATOR SOLUTION # HR - 2497. </Product> Part#: N/A 22 APR 2010 300088 MATERIAL SAFETY DATA SHEET PHENOLPHTHALEIN INDICATOR SOLUTION # HR - 2497 Part#: N/A SECTION I SUPPLIER INFORMATION Common Name : PHENOLPHTHALEIN

More information

MATERIAL SAFETY DATA SHEET

MATERIAL SAFETY DATA SHEET MATERIAL SAFETY DATA SHEET WORLD PRECISION INSTRUMENTS EMERGENCY NUMBER 941/371-1003 1/800/535-5053 175 Sarasota Center Blvd DATE PREPARED: Sarasota, FL 34240 12/01/95 Rev 02 SECTION I CHEMICAL IDENTIFICATION

More information

Technical Data Sheet

Technical Data Sheet Februar, 2014 Technical Data Sheet PLA Polylactide Cas No. 9051-89-2 PLA is a thermoplastic resin derived from annually renewable resources Product Characteristics Typical Properties Value Unit Physical

More information

SAFETY DATA SHEET Glen-Pak TM DNA purification cartridge (for use with disposable syringes) 60-5200-xx

SAFETY DATA SHEET Glen-Pak TM DNA purification cartridge (for use with disposable syringes) 60-5200-xx Product Code: Product Name: Product Use: Manufacturer Information Company Name: SAFETY DATA SHEET 1. Product and Company Identification 60-5200-xx Glen-Pak TM DNA purification cartridge For Research Use

More information

APPLIED PETROCHEMICAL RESEARCH

APPLIED PETROCHEMICAL RESEARCH Common Name Manufactured by CAS Number HYDRIC ACID Revised 07/23/1987 Source of MSDS APPLIED PETROCHEMICAL RESEARCH Dolphin (DOL$270453) I II - Hazard Ingredients/Identity Information III - Physical/Chemical

More information

http://complyplus.grainger.com/grainger/msds.asp?sheetid=2811386

http://complyplus.grainger.com/grainger/msds.asp?sheetid=2811386 Page 1 of 5 Common Name: SPY GLASS Manufacturer: RAMSEY MSDS Revision Date: 1/1/2000 Grainger Item Number(s): 2U095, 2U110 Manufacturer Model Number(s): 70117, SPY GLASS MSDS Table of Contents Click the

More information

SAFETY DATA SHEET. Mouse Microphage Microsomal Immunoblot Control

SAFETY DATA SHEET. Mouse Microphage Microsomal Immunoblot Control according to Regulation (EC) No. 1907/2006 as amended by (EC) No. 1272/2008 Section 1. Identification of the Substance/Mixture and of the Company/Undertaking Page: 1 of 5 1.1 Product Code: Product Name:

More information

MATERIAL SAFETY DATA SHEET

MATERIAL SAFETY DATA SHEET SECTION 1 GENERAL INFORMATION Manufacturer: HMIS Rating Modern Masters, Inc. HEALTH 1 9380 San Fernando Road FLAMMABILITY 0 Sun Valley, CA 91352 REACTIVITY 0 818-683-0201 Emergency Telephone: 800-942-3166

More information

CAS NO. A. 7664-93-9 >94.19 % WT >94.19 % VOL SARA 313 NO

CAS NO. A. 7664-93-9 >94.19 % WT >94.19 % VOL SARA 313 NO SECTION 1: PRODUCT AND COMPANY IDENTIFICATION PRODUCT NAME: FLOWEASY DRAIN CLEANER SYNONYMS: N/A PRODUCT CODES: HTL-FE16, HTL-FE20, HTL-FE32, HTL-FE64, HTL-FE128 MANUFACTURER: Hi-Tec Laboratories DIVISION:

More information

SAFETY DATA SHEET FILE NO.: 514122, 514123 DRY CIDER VINEGAR SDS DATE: 05/05/15

SAFETY DATA SHEET FILE NO.: 514122, 514123 DRY CIDER VINEGAR SDS DATE: 05/05/15 SECTION 1: PRODUCT AND COMPANY IDENTIFICATION PRODUCT NAME: Dry Cider Vinegar PRODUCT CODES: 514122, 514123 MANUFACTURED FOR: ADDRESS: Best Veterinary Solutions, Inc 1716 Detroit St., Ellsworth, IA 50075

More information

MATERIAL SAFETY DATA SHEET

MATERIAL SAFETY DATA SHEET Section I: IDENTIFICATION 1 OF 2 Date Prepared: 02/15/02 Date Revised*: 09/21/06 Product Name: Gram Stain, Lugol s Iodine Item Number: 400312, 400330, 400350, 400352, 400314, 400351, 400356, 400312B 400312A

More information

SECTION 1 - PRODUCT IDENTIFICATION

SECTION 1 - PRODUCT IDENTIFICATION Product Identification Physical Data Hazardous Components Fire and Explosion Hazard Data Reactivity Data Health Hazard Information Spill or Leak Procedures Handling Information Special Protection Information

More information

The Illinois Law Enforcement Intern Training Program Application for Admission

The Illinois Law Enforcement Intern Training Program Application for Admission The Illinois Law Enforcement Intern Training Program Application for Admission Instructions for completion of application: 1. Please print or type in black ink. 2. Do not leave any question blank. If the

More information

1. Chemical Product and Company Identification. 2. Hazardous Ingredients

1. Chemical Product and Company Identification. 2. Hazardous Ingredients 1. Chemical Product and Company Identification Product Name Company Name Company Name Website Houghton International Inc. Madison & Van Buren Aves Valley Forge, PA 19482 Houghton Canada Inc. 115 Walker

More information

MATERIAL SAFETY DATA SHEET Page 1 of 7 Revised 1/17/01 BRIJ 35 SP Replaces 2/22/99 UNIQEMA As of 2/16/01. Material Name: BRIJ(R) 35SP

MATERIAL SAFETY DATA SHEET Page 1 of 7 Revised 1/17/01 BRIJ 35 SP Replaces 2/22/99 UNIQEMA As of 2/16/01. Material Name: BRIJ(R) 35SP MATERIAL SAFETY DATA SHEET Page 1 of 7 1 CHEMICAL PRODUCT AND COMPANY IDENTIFICATION Material Name: BRIJ(R) 35SP Uniqema Uniqema Corporate Center 1000 Uniqema Boulevard New Castle, DE 19720-2790 Uniqema

More information

Authorization to Attend. Law Enforcement/Corrections Academy

Authorization to Attend. Law Enforcement/Corrections Academy TO ALL AGENCIES: Agencies have several methods of sending a recruit to the basic recruit program here at Palm Beach State College. The first way is to sponsor the recruit. A sponsored recruit is one in

More information

Carpet Seam Sealer 8200

Carpet Seam Sealer 8200 Carpet Seam Sealer 8200 DESCRIPTION Shaw 8200 is recommended for seaming/sealing most types of carpet in direct glue down installation. Shaw 8200 can also be used in double stick applications; however,

More information

MATERIAL SAFETY DATA SHEET Complies with ANSI Z400.1 Format SECTION 1: PRODUCT IDENTIFICATION

MATERIAL SAFETY DATA SHEET Complies with ANSI Z400.1 Format SECTION 1: PRODUCT IDENTIFICATION Staples the Office Superstore, LLC. MSDS 500 Staples Drive Hazard Rating HMIS NFPA Framingham, MA 01702 USA Health Business Phone: 1.800.322.0912 Flammability 24-HR MEDICAL AND DOT EMERGENCIES: 1.800.322.0912

More information

Gulf Coast State College Division of Public Safety. Charles H. Abbott Public Safety Training Center

Gulf Coast State College Division of Public Safety. Charles H. Abbott Public Safety Training Center Gulf Coast State College Division of Public Safety Charles H. Abbott Public Safety Training Center Florida Law Enforcement Academy (LEA) Basic Recruit Training Program Application Program Director: John

More information

Material Safety Data Sheet

Material Safety Data Sheet Date of Issue: 26/5/2009 MSDS No.: Q54-1300B Material Safety Data Sheet 1. PRODUCT AND COMPANY IDENTIFICATION Product Name : Daily Maintenance Kit(Wipe Cleaning) Product Code : IP6-108 -Application model

More information

TRICHLOROACETIC ACID SOLUTION Department of Pharmacy Duke University Medical Center Box 3089 Durham, NC 27710 919-684-5125

TRICHLOROACETIC ACID SOLUTION Department of Pharmacy Duke University Medical Center Box 3089 Durham, NC 27710 919-684-5125 Page 1 of 5 1. IDENTIFICATION OF SUBSTANCE Name: Manufacturer: TRICHLOROACETIC ACID SOLUTION Department of Pharmacy Duke University Medical Center Box 3089 Durham, NC 27710 919-684-5125 Information Department:

More information

INGREDIENTS CAS No. CONTENTS(%) OSHA ACGIH

INGREDIENTS CAS No. CONTENTS(%) OSHA ACGIH M A T E R I A L S A F E T Y D A T A S H E E T page 1/ 4 S - 2 0 0 E * Updated : October 28, 2010 MSDS No. : MS- 00163201-03 SECTION 1 IDENTIFICATION MANUFACTURER TAIYO INK MFG. CO., LTD. TEL 81-493- 61-2832

More information

Version 1. Print Date 12/01/2009 Revision Date 11/30/2009 MSDS Number 350000004298 SITE_FORM Number 30000000000000003622.001

Version 1. Print Date 12/01/2009 Revision Date 11/30/2009 MSDS Number 350000004298 SITE_FORM Number 30000000000000003622.001 1. PRODUCT AND COMPANY IDENTIFICATION Product information Trade name : Use of the : Drain Cleaner Substance/Mixture Company : S.C. Johnson & Son, Inc. 1525 Howe Street Racine WI 53403-2236 Emergency telephone

More information

SECTION 3: COMPOSITION/INFORMATION ON INGREDIENTS 3.1. Substances Not applicable 3.2. Mixture

SECTION 3: COMPOSITION/INFORMATION ON INGREDIENTS 3.1. Substances Not applicable 3.2. Mixture Revision Date: 05/19/2015 Date of issue: 05/19/2015 Version: 1.0 SECTION 1: IDENTIFICATION 1.1. Product Identifier Product Form: Mixture Product Name: 10X Spheroid Formation ECM Product Code: 3500-096-01

More information

Material Safety Data Sheet

Material Safety Data Sheet Material Safety Data Sheet Identity - A WATERBASED LIQUID ADHESIVE Product # Fast Dry Padding Compound *Section 1: Chemical Product and Company Identification Manufacturer s name: Emergency Telephone Number:

More information

Material Safety Data Sheet

Material Safety Data Sheet Material Safety Data Sheet Export - Portland Cement - Dry Powder Blend QUICK IDENTIFIER (See Section 1 Product Name) SECTION 1- IDENTIFICATION OF PREPARATION AND COMPANY Product: Application: Manufacturer

More information

HAZARD COMMUNICATION & THE GLOBAL HARMONIZING SYSTEM EMPLOYEE TRAINING

HAZARD COMMUNICATION & THE GLOBAL HARMONIZING SYSTEM EMPLOYEE TRAINING HAZARD COMMUNICATION & THE GLOBAL HARMONIZING SYSTEM EMPLOYEE TRAINING This easy-to-use Leader s Guide is provided to assist in conducting a successful presentation. Featured are: INTRODUCTION: A brief

More information

Material Safety Data Sheet Brilliant Green, 1% Aqueous. Section 1 - Chemical Product and Company Identification

Material Safety Data Sheet Brilliant Green, 1% Aqueous. Section 1 - Chemical Product and Company Identification ISO9001:2000 Certified Material Safety Data Sheet Section 1 - Chemical Product and Company Identification MSDS Name: Catalog Numbers: Q00811 Synonyms: Company Identification: Qorpak 1195 Washington Pike

More information

CITY OF COCONUT CREEK Department of Human Resources 4800 W. Copans Road Coconut Creek, FL 33063

CITY OF COCONUT CREEK Department of Human Resources 4800 W. Copans Road Coconut Creek, FL 33063 OPENING DATE: 08/11/15 CLOSING DATE: 09/09/15 THE POSITION Salary: $24.52/Hour GENERAL PURPOSE: CITY OF COCONUT CREEK Department of Human Resources 4800 W. Copans Road Coconut Creek, FL 33063 http://www.coconutcreek.net

More information

PERSONAL HISTORY STATEMENT

PERSONAL HISTORY STATEMENT NORTH CAROLINA CRIMINAL JUSTICE EDUCATION AND TRAINING STANDARDS COMMISSION CRIMINAL JUSTICE STANDARDS DIVISION TELEPHONE: (919) 716-6470 It is the determination of the Commission that these questions

More information

MATERIAL SAFETY DATA SHEET Page 01 of 05

MATERIAL SAFETY DATA SHEET Page 01 of 05 MATERIAL SAFETY DATA SHEET Page 01 of 05 83D SUPER 300 F-A-G 16 FO CN 80058 1. CHEMICAL PRODUCT AND COMPANY IDENTIFICATION Part No.: 83D Product Type: Sealant 2. COMPOSITION, INFORMATION ON INGREDIENTS

More information

Material Safety Data Sheet. Chemical Product and Company Identification Product Name or Number:

Material Safety Data Sheet. Chemical Product and Company Identification Product Name or Number: Section 1 Chemical Product and Company Identification Product Name or Number: G, H, K, L and M Filament Texturized Rovings -- E Glass Products Date of Preparation or Last Change: November 3, 1997 Section

More information

* * * EMERGENCY OVERVIEW * * * High pressure gas. Can cause rapid suffocation. Can increase respiration and heart rate.

* * * EMERGENCY OVERVIEW * * * High pressure gas. Can cause rapid suffocation. Can increase respiration and heart rate. SUPPLIER ADDRESS: PRODUCT NAME: Saxon Wharf, Lower York St Southampton SO14 5QF, UK 1. CHEMICAL PRODUCT EMERGENCY PHONE NUMBER: COMPRESSED GAS, N.O.S. SYNONYMS: None (Contains: CARBON DIOXIDE & NITROGEN)

More information

Seahorse Bioscience SAFETY DATA SHEET

Seahorse Bioscience SAFETY DATA SHEET Seahorse Bioscience SAFETY DATA SHEET United States Section 1. Identification of the Mixture and of the Company 1.1 Product Code: 102720-100 Product Name: XF Palmitate-BSA 1.2 Relevant identified uses

More information

SAFETY DATA SHEET.alpha.-pyrrolidinopentiophenone (hydrochloride)

SAFETY DATA SHEET.alpha.-pyrrolidinopentiophenone (hydrochloride) according to Regulation (EC) No. 1907/2006 as amended by (EC) No. 1272/2008 Section 1. Identification of the Substance/Mixture and of the Company/Undertaking Page: 1 of 5 1.1 Product Code: Product Name:

More information

MATERIAL SAFETY DATA SHEET MSDS No.: 003 Revision No.: 5 Effective Date 2/2/2015

MATERIAL SAFETY DATA SHEET MSDS No.: 003 Revision No.: 5 Effective Date 2/2/2015 PRODUCT AND COMPANY INFORMATION SECTION 1 Manufacturer/Distributor Product Name: Synonyms: Intended Use: Water-Jel Technologies 50 Broad Street Carlstadt, NJ 07072 201-507-8300 800-275-3433 Burn Jel Burn

More information

MATERIAL SAFETY DATA SHEET

MATERIAL SAFETY DATA SHEET Material Safety Data Sheet:- DIHYDROGEN MONOXIDE Page No. 2 of 5. - - 1/7/2008. Date: January 7, 2008 Replaces MSDS Dated: MATERIAL SAFETY DATA SHEET Manufacturer(s) NFPA Designation 704 GENERIC (UBIQUITOUS)

More information

Trade Name of this Product Isopropyl Rubbing Alcohol 91% USP. Corporate Compliance Team 1666 East Touhy Avenue

Trade Name of this Product Isopropyl Rubbing Alcohol 91% USP. Corporate Compliance Team 1666 East Touhy Avenue Page 1 of 5 MSDS Document Product 1. Chemical Product and Company Identification Trade Name of this Product Manufacturer Contact Name Lawson Products, Inc. Corporate Compliance Team 1666 East Touhy Avenue

More information

MATERIAL SAFETY DATA SHEET

MATERIAL SAFETY DATA SHEET Page 1 of 5 SECTION I: PRODUCT INFORMATION REVISION DATE: February 1 st, 2015 USAGE: ONE COMPONENT URETHANE BASED SEALANT MANUFACTURER/SUPPLIER: SIKA CANADA INC. 601, avenue Delmar Pointe Claire, QC H9R

More information

Material Safety Data Sheet

Material Safety Data Sheet Material Safety Data Sheet Section 1 General Information Manufacturer: Zinsser Company, Inc. 173 Belmont Drive Somerset, NJ 08875 (732) 469-8100 Emergency Telephone: Chemtrec (800) 424-9300 Date: December

More information

D. EDUCATION/TRAINING

D. EDUCATION/TRAINING MOUNTAIN HOME POLICE DEPARTMENT EMPLOYMENT APPLICATION Positive, Professional, Productive, Proactive An Equal Opportunity Employer Applicant Full Name: Date: A. INSTRUCTIONS Application must be typewritten

More information

MATERIAL SAFETY DATA SHEET Page 01 of 05

MATERIAL SAFETY DATA SHEET Page 01 of 05 MATERIAL SAFETY DATA SHEET Page 01 of 05 Loctite(R) Plumber's Choice(TM) Sealant 25826 1. CHEMICAL PRODUCT AND COMPANY IDENTIFICATION Product Type: ADHESIVE 2. COMPOSITION, INFORMATION ON INGREDIENTS Ingredients

More information

FRUITA POLICE DEPARTMENT

FRUITA POLICE DEPARTMENT FRUITA POLICE DEPARTMENT Personal History Form for Police Officer Applicants Personal Full Legal Last First Middle Name Sex Height Weight Hair Eyes Social Security Number Driver s License No. State Expiration

More information

MATERIAL SAFETY DATA SHEET

MATERIAL SAFETY DATA SHEET MATERIAL SAFETY DATA SHEET SECTION 1 -- CHEMICAL PRODUCT AND COMPANY IDENTIFICATION PRODUCT NAME Sav-A-Hoof Protectant PRODUCT CODE 309 ISSUE DATE 11/15/14 EMERGENCY TELEPHONE NUMBERS DISTRIBUTOR SBS EQUINE

More information

SAFETY DATA SHEET Enz-Extract Enzyme Carpet Extractor. 1. Product and Company Identification. 2. Hazards Identification

SAFETY DATA SHEET Enz-Extract Enzyme Carpet Extractor. 1. Product and Company Identification. 2. Hazards Identification Page: 1 7/21/215 4/1/215 Product Code: Product Name: Company Name: Web site address: 7759 Genlabs 5568 Schaefer Ave. Chino, CA 9171 Phone Number: 1 (99)591-8451 Emergency Contact: Chemtrec 1 (8)424-93

More information

SAFETY DATA SHEET For Coatings, Resins, and Related Materials

SAFETY DATA SHEET For Coatings, Resins, and Related Materials SAFETY DATA SHEET For Coatings, Resins, and Related Materials Complies with U.S. Department of Labor Occupational Safety and Health Administration For OSHA Hazard Communication Standard Specific Requirements

More information

Material Safety Data Sheet. NFGA Rating: Health: 1 Flammability: 1 Instability: 0. HMIS Rating: Health: 1 Flammability: 1 Physical Hazard: 0

Material Safety Data Sheet. NFGA Rating: Health: 1 Flammability: 1 Instability: 0. HMIS Rating: Health: 1 Flammability: 1 Physical Hazard: 0 Material Safety Data Sheet OSHA/ANSI 2003 Compliant Date: 05/2/2009 NFGA Rating: Health: 1 Flammability: 1 Instability: 0 HMIS Rating: Health: 1 Flammability: 1 Physical Hazard: 0 1. PRODUCT AND COMPANY

More information

Material Safety Data Sheet

Material Safety Data Sheet 1. Product & Company Identification: Product Manufacturer: Model: Nominal capacity: LiPo-Akku Conrad Electronic SE LiPo-Akku 3.7V 130mAh 130mAh Nominal voltage: 3.7V Address: Klaus-Conrad-Strasse 1, D-92242

More information

1. IDENTIFICATION OF SUBSTANCE/MIXTURE AND OF THE COMPANY/UNDERTAKING.

1. IDENTIFICATION OF SUBSTANCE/MIXTURE AND OF THE COMPANY/UNDERTAKING. P a g e 1 1. IDENTIFICATION OF SUBSTANCE/MIXTURE AND OF THE COMPANY/UNDERTAKING. 2925 MFG Place Ashtabula, OH 44005 Emergency Telephone Number 1-800-424-9300 Regulatory Information Number 1-440-994-5207

More information

SAFETY DATA SHEET (±)-Anatoxin A (fumarate) Section 2. Hazards Identification

SAFETY DATA SHEET (±)-Anatoxin A (fumarate) Section 2. Hazards Identification Page: 1 1.1 Product Code: Product Name: Synonyms: according to Regulation (EC) No. 1907/2006 as amended by (EC) No. 1272/2008 Section 1. Identification of the Substance/Mixture and of the Company/Undertaking

More information

STATE OF MAINE DEPARTMENT OF PUBLIC SAFETY MAINE CRIMINAL JUSTICE ACADEMY 15 OAK GROVE ROAD VASSALBORO, MAINE 04989

STATE OF MAINE DEPARTMENT OF PUBLIC SAFETY MAINE CRIMINAL JUSTICE ACADEMY 15 OAK GROVE ROAD VASSALBORO, MAINE 04989 JOHN ELIAS BALDACCI GOVERNOR STATE OF MAINE DEPARTMENT OF PUBLIC SAFETY MAINE CRIMINAL JUSTICE ACADEMY 15 OAK GROVE ROAD VASSALBORO, MAINE 04989 MICHAEL P. CANTARA COMMISSIONER JOHN B. ROGERS DIRECTOR

More information

MATERIAL SAFETY DATA SHEET

MATERIAL SAFETY DATA SHEET Page 1 of 5 SECTION I: PRODUCT INFORMATION REVISION DATE: April 27 th, 2015 USAGE: SUPPLIER: SIKA CANADA INC. 601, avenue Delmar Pointe Claire, QC H9R 4A9 EMERGENCY TELEPHONE NUMBER: CANUTEC (collect)

More information

MATERIAL SAFETY DATA SHEET FILE NO.: B ZOOM Drain Care System (Liquid Drain Opener) MSDS DATE:9/17/08

MATERIAL SAFETY DATA SHEET FILE NO.: B ZOOM Drain Care System (Liquid Drain Opener) MSDS DATE:9/17/08 SECTION 1: PRODUCT AND COMPANY IDENTIFICATION PRODUCT NAME: SYNONYMS: PRODUCT CODES: MANUFACTURER: BO-MAR INDUSTRIES, INC. DIVISION: ADDRESS: 3620 Commerce Drive #710 EMERGENCY PHONE: 443-709-0515 CHEMTREC

More information

************************************************************************ *** SECTION 1 PRODUCT IDENTIFICATION

************************************************************************ *** SECTION 1 PRODUCT IDENTIFICATION MATERIAL SAFETY DATA SHEET Pure Tech Emergency Phone Numbers: P.O. Box 1950 CHEMTREC: 800/424-9300 Brewster, New York 10509-8950 POISON CENTER: 800/562-8236 845/279-0900 Date of Last Revision: 03-21-97

More information

Section 1 Chemical Product and Company Identification Product Name : Power Hydrol HLP 32. Chemical Family : Refined Paraffinic Petroleum Distillate.

Section 1 Chemical Product and Company Identification Product Name : Power Hydrol HLP 32. Chemical Family : Refined Paraffinic Petroleum Distillate. Apar Industries Limited Material Safety Data Sheet. Section 1 Chemical Product and Company Identification Product Name : Power Hydrol HLP 32. Chemical Family : Refined Paraffinic Petroleum Distillate.

More information

SAFETY DATA SHEET Rivaroxaban. Section 2. Hazards Identification

SAFETY DATA SHEET Rivaroxaban. Section 2. Hazards Identification Page: 1 of 6 according to Regulation (EC) No. 1907/2006 as amended by (EC) No. 1272/2008 Section 1. Identification of the Substance/Mixture and of the Company/Undertaking 1.1 Product Code: Product Name:

More information

Application Checklist

Application Checklist Application Checklist POSITION APPLIED FOR: Indian Preference shall not be claimed without proof. Submitted applications without copies of verification documents, unanswered questions, omitted dates, omitted

More information

SAFETY DATA SHEET Polypropylene Copolymer Resin. 1. Product and Company Identification. 2. Hazards Identification

SAFETY DATA SHEET Polypropylene Copolymer Resin. 1. Product and Company Identification. 2. Hazards Identification Page: 1 1. Product and Company Identification Product Name: Trade Name: Company Name: Web site address: Emergency Contact: Information: Certene Muehlstein Ravago Americas 10 Westport Rd Wilton, CT 06897

More information

SAFETY DATA SHEET. Trade name: Master Clear Seal-5 Revised: 5/29/2015

SAFETY DATA SHEET. Trade name: Master Clear Seal-5 Revised: 5/29/2015 MMG Mud Masters Group a division of Horizon Mud Company SAFETY DATA SHEET SECTION 1: Identification of the substance/mixture and of the company/undertaking Trade name: Master Clear Seal-5 Supplied by:

More information

PRODUCT ID: LIDOCAINE HYDROCHLORIDE AND EPINEPHRINE INJECTION

PRODUCT ID: LIDOCAINE HYDROCHLORIDE AND EPINEPHRINE INJECTION SECTION 15: REGULATORY INFORMATION This product has been classified in accordance with the hazard criteria of the Controlled Products Regulations and the MSDS contains all the information required by the

More information

EMERGENCY PHONE: 1-800-364-3577 or (651) 737-6501 (24 hours)

EMERGENCY PHONE: 1-800-364-3577 or (651) 737-6501 (24 hours) Material Safety Data Sheet Copyright, 2006, 3M Company. All rights reserved. Copying and/or downloading of this information for the purpose of properly utilizing 3M products is allowed provided that: (1)

More information

SDS. GHS Safety Data Sheet. Wechem, Inc. Extract All PRODUCT AND COMPANY IDENTIFICATION. Manufacturer HAZARDS IDENTIFICATION

SDS. GHS Safety Data Sheet. Wechem, Inc. Extract All PRODUCT AND COMPANY IDENTIFICATION. Manufacturer HAZARDS IDENTIFICATION Page 1 of 5 1 PRODUCT AND COMPANY IDENTIFICATION Manufacturer Wechem, Inc 5734 Susitna Dr Harahan, LA 70123 Contact: Phone: Fax: Web: Ligia M. Hernandez 504-733-1152 504-733-2218 www.wechem.com Product

More information

EASTERN FLORIDA STATE COLLEGE PUBLIC SAFETY INSTITUTE

EASTERN FLORIDA STATE COLLEGE PUBLIC SAFETY INSTITUTE EASTERN FLORIDA STATE COLLEGE PUBLIC SAFETY INSTITUTE Application for the 911 Public Safety TelecommunicatorAcademy RETURN THIS ENTIRE APPLICATION AND ALL REQUESTED SUPPORTING DOCUMENTATION IN PERSON OR

More information

BBQ Master Hong Kong Limited

BBQ Master Hong Kong Limited BBQ Master Hong Kong Limited Instant Light Charcoal Emergency Phone Number: For Chemical Emergency Spill Leak Fire Exposure or Accident Call CHEMTREC Day or Night DOMESTIC NORTH AMERICA 800-424-9300 SECTION

More information

: Water and Glycol Leak Detection Solution

: Water and Glycol Leak Detection Solution Water and Glycol Leak Detection Solution Safety Data Sheet according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations Date of issue: 05/05/2015 Version: 1 SECTION

More information

MATERIAL SAFETY DATA SHEET

MATERIAL SAFETY DATA SHEET MATERIAL SAFETY DATA SHEET 1. Product and Supplier Identification Product Name: Product: Chemical Name: Product Use: Glass Fiber Woven Cloth Orca Composites Woven Cloth (All) E-Glass FRP Manufacturing

More information

Material Safety Data Sheet

Material Safety Data Sheet Permatex, Inc. 10 Columbus Blvd. Hartford, CT 06106 USA Telephone: 1-87-Permatex (877) 376-2839 Emergency: 800-255-3924 International Emergency: 813-348-0585 1. PRODUCT IDENTIFICATION Product Name: Item

More information

REPORT OF EXAMINATION To be on file at the Academy

REPORT OF EXAMINATION To be on file at the Academy SOUTH CAROLINA CRIMINAL JUSTICE ACADEMY 5400 Broad River Road Columbia, South Carolina 29212-3540 (803) 896-7802 * * * * * * MEDICAL HISTORY, EXAMINATION, AND FITNESS FOR TRAINING TO THE EMPLOYER: This

More information

INDIAN RIVER STATE COLLEGE

INDIAN RIVER STATE COLLEGE INDIAN RIVER STATE COLLEGE Criminal Justice Institute Region XI Selection Center Policy and Procedure Manual Evan Berry Asst. Dean of Public Service Education Lee Spector Director, Criminal Justice Institute

More information

Safety Data Sheet SOMAmer Reagent

Safety Data Sheet SOMAmer Reagent SECTION 1: Identification Safety Data Sheet SOMAmer Reagent 1.1 Product identifier Product name SOMAmer Reagent (aptamer) 1.2 Supplier s details Name Address Email SomaLogic, Inc. 2945 Wilderness Place

More information

MATERIAL SAFETY DATA SHEET MSDS No.: 007

MATERIAL SAFETY DATA SHEET MSDS No.: 007 PRODUCT AND COMPANY INFORMATION SECTION 1 Water-Jel Technologies 50 Broad Street Manufacturer/Distributor Carlstadt, NJ 07072 201-507-8300 800-275-3433 Product Name: Synonyms: Topical Cream, Burn Cream

More information

Safety Data Sheet SECTION 2: HAZARDS IDENTIFICATION

Safety Data Sheet SECTION 2: HAZARDS IDENTIFICATION AST-PPD Plumbers Pipe Dope Safety Data Sheet SECTION 1: IDENTIFICATION Product Name: AST-PPD Plumbers Pipe Dope Manufacturer/ Supplier: Anti-Seize Technology 2345 N. 17th Ave. Franklin Park, IL 60131 Phone:

More information

MATERIAL SAFETY DATA SHEET KRC-7 Bathroom Cleaner & Restorer SECTION 1 PRODUCT NAME AND COMPANY IDENTIFICATION

MATERIAL SAFETY DATA SHEET KRC-7 Bathroom Cleaner & Restorer SECTION 1 PRODUCT NAME AND COMPANY IDENTIFICATION SECTION 1 PRODUCT NAME AND COMPANY IDENTIFICATION Product Name: KRC-7 ULTRA Bathroom Cleaner & Restorer Manufacturer: Chemique, Inc. 315 N. Washington Avenue Moorestown, NJ 08057 (856) 235-4161 MSDS Date

More information

CITY OF COCONUT CREEK Department of Human Resources 4800 W. Copans Road Coconut Creek, FL 33063

CITY OF COCONUT CREEK Department of Human Resources 4800 W. Copans Road Coconut Creek, FL 33063 OPENING DATE: 03/23/16 CLOSING DATE: 04/07/16 THE POSITION CITY OF COCONUT CREEK Department of Human Resources 4800 W. Copans Road Coconut Creek, FL 33063 http://www.coconutcreek.net INVITES APPLICATIONS

More information

Application for New Louisiana Pharmacy Technician Candidate Registration

Application for New Louisiana Pharmacy Technician Candidate Registration Louisiana Board of Pharmacy 3388 Brentwood Drive Baton Rouge, Louisiana 70809-1700 Telephone 225.925.6496 ~ Facsimile 225.925.6499 www.pharmacy.la.gov ~ E-mail: info@pharmacy.la.gov Application for New

More information

Mississippi Security Police Inc. 3003 Pascagoula Street Pascagoula, MS 39567 228.762.0661 228.769.5583 fax

Mississippi Security Police Inc. 3003 Pascagoula Street Pascagoula, MS 39567 228.762.0661 228.769.5583 fax Mississippi Security Police Inc. 3003 Pascagoula Street Pascagoula, MS 39567 228.762.0661 228.769.5583 fax Dear Applicant: Please comply with the following requirements. Please review qualifications and

More information

BRANFORD POLICE DEPARTMENT Employment Application

BRANFORD POLICE DEPARTMENT Employment Application NAME LAST, FIRST ID #: OFFICE USE ONLY MAILING ADDRESS: STREET CITY STATE ZIP BRANFORD POLICE DEPARTMENT Employment Application Recruit and Lateral Transfers Applications Due By: Wednesday, June 30, 2015

More information

APPLICANTS OF FIRE FIGHTER/EMT

APPLICANTS OF FIRE FIGHTER/EMT APPLICANTS OF FIRE FIGHTER/EMT The documentation listed below must be completed, notarized, and stapled to the back of your employment application and returned to the Personnel Department. Applications

More information

Ingredient CAS Number Weight % ACGIH TLV PEL STEL Phosphoric Acid 7664-38-2 1 mg/m3 1 mg/m3 3 mg/m3

Ingredient CAS Number Weight % ACGIH TLV PEL STEL Phosphoric Acid 7664-38-2 1 mg/m3 1 mg/m3 3 mg/m3 Page 1 of 5 MSDS Document Product 1. Chemical Product and Company Identification Product Manufacturer Haviland Consumer Products, Inc. 421 Ann Street N.W. Grand Rapids, MI 49504 Phone Number (616) 361-6691

More information

Safety Data Sheet SECTION 1: IDENTIFICATION SECTION 2: HAZARD(S) IDENTIFICATION SECTION 3: COMPOSITION/INFORMATION ON INGREDIENTS

Safety Data Sheet SECTION 1: IDENTIFICATION SECTION 2: HAZARD(S) IDENTIFICATION SECTION 3: COMPOSITION/INFORMATION ON INGREDIENTS Safety Data Sheet SECTION 1: IDENTIFICATION Chemical Name: Trade name and synonyms: Chemical Family: Formula: Tungsten metal Wolfram Refractory Metal (non-ferrous metal) W CAS Number: 7440-33-7 SECTION

More information

Graphene Water Dispersion

Graphene Water Dispersion Graphene Water Dispersion US Research Nanomaterials, Inc. Material Safety Data Sheet acc. to OSHA and ANSI 1 - Identification of substance: Chemical Name: Graphene Water Dispersion Synonyms: natural graphite

More information

MATERIAL SAFETY DATA SHEET

MATERIAL SAFETY DATA SHEET Page: 1 of 5 SECTION I - PRODUCT IDENTIFICATION Name: Pitney Bowes Red Fluorescent Use: Thermal Ribbons for B700 Postage Meter Machines Chemical Name: t Applicable Chemical Family: t Applicable Reorder

More information

MATERIAL SAFETY DATA SHEET E Z House Wash 56oz. 1. Product and Company Identification. 2. Composition/Information on Ingredients

MATERIAL SAFETY DATA SHEET E Z House Wash 56oz. 1. Product and Company Identification. 2. Composition/Information on Ingredients Page: 1 Product Code: Product Name: Reference #: Manufacturer Information Company Name: Phone Number: Emergency Contact: Information: Web site address: Preparer Name: sodium HEALTH FLAMMABILITY PHYSICAL

More information

MATERIAL SAFETY DATA SHEET FOR OZONE GAS Ozilla Ozone Sterilizer SECTION 1. CHEMICAL IDENTIFICATION

MATERIAL SAFETY DATA SHEET FOR OZONE GAS Ozilla Ozone Sterilizer SECTION 1. CHEMICAL IDENTIFICATION SECTION 1. CHEMICAL IDENTIFICATION PRODUCT NUMBERS: E400110, E400220 NAMES: Ozilla Ozone Sterilizer, 110 volts. Ozilla Ozone Sterilizer, 220 volts. COMMON SYNONYMS: Triatomic Oxygen, Trioxygen, O 3 CHEMICAL

More information

Independent Forensics of Illinois

Independent Forensics of Illinois Independent Forensics of Illinois RSID -Semen Lab kit Universal Buffer #0230 Material Safety Data Sheet Date Updated: 01/2014 SECTION 1 - CHEMICAL PRODUCT AND COMPANY IDENTIFICATION MSDS Name: RSID -SEMEN

More information

GLADE FABRIC & AIR ODOR ELIMINATOR - CLEAN LINEN

GLADE FABRIC & AIR ODOR ELIMINATOR - CLEAN LINEN 1. PRODUCT AND COMPANY IDENTIFICATION Product information Trade name : GLADE FABRIC & AIR ODOR ELIMINATOR - CLEAN LINEN Use of the : Speciality Cleaner Substance/Preparation Company : S.C. Johnson & Son,

More information

Material Safety Data Sheet

Material Safety Data Sheet Material Safety Data Sheet 1. CHEMICAL PRODUCT AND COMPANY INFORMATION Chemical Product Name Sodium Chloride (Salt) Chemical Family Alkali Metal/Halide Chemical Name Sodium Chloride Formula NaCl Molecular

More information

NFPA Hazard Class: * Physical Form: Solid. Health: 0 (Least) * Appearance: Yellow Flammability: 1 (Slight)

NFPA Hazard Class: * Physical Form: Solid. Health: 0 (Least) * Appearance: Yellow Flammability: 1 (Slight) Safety Data Sheet Microcrystalline Wax 1. Chemical Product Identification Generic Name: Microcrystalline Wax INCI Name: Microcrystalline Wax Chemical Family: Mineral Emergency Telephone Numbers: Page 1

More information

1. IDENTIFICATION OF THE SUBSTANCE/PREPARATION AND THE COMPANY/UNDERTAKING

1. IDENTIFICATION OF THE SUBSTANCE/PREPARATION AND THE COMPANY/UNDERTAKING (HU-650) 1. IDENTIFICATION OF THE SUBSTANCE/PREPARATION AND THE COMPANY/UNDERTAKING Product name : HU-650 ABS Polymers Generic name : ABS Graft Copolymer Chemical product name : Acrylonitrile Butadiene

More information

M A T E R I A L S A F E T Y D A T A S H E E T

M A T E R I A L S A F E T Y D A T A S H E E T Page: 1 1. CHEMICAL PRODUCT AND COMPANY IDENTIFICATION Product Name: SAVOGRAN COMPANY PO BOX 130 NORWOOD, MA 02062-0130 (781) 762-5400 2. COMPOSITION/INFORMATION ON INGREDIENTS Component/Exposure Limits

More information

MATERIAL SAFETY DATA SHEET Mold Armor E-Z Deck Wash. 1. Product and Company Identification

MATERIAL SAFETY DATA SHEET Mold Armor E-Z Deck Wash. 1. Product and Company Identification Page: 1 Product Code: Product Name: Manufacturer Information Flammability Instability HEALTH 1 0 FLAMMABILITY 0 0 1 PHYSICAL Health PPE X Special Hazard 1. Product and Company Identification 63000.003E

More information