Form 119-25-5 National Fire Academy Executive Fire Officer Program App

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY

NATIONAL FIRE ACADEMY
Executive Fire Officer Program
Application for Admission

Dear Applicant:
Due to the limited number of available spaces within the program for each fiscal year, your
applications will become part of a competitive selection process whereby our admissions committee
will select the most qualified applicants for the program.
The information provided on the FEMA Form 119-25-5, along with information provided on the
FEMA Form 119-25-1, will be the basis for selection. The FEMA Form 064-0-3 application must
be received no later than close of business on June 15. Applications received after this date will
not be considered for the selection process.
We look forward to receiving your application.
Sincerely,

Denis Onieal
Superintendent
National Fire Academy

Enclosure

Privacy Act Statement
General - This information is provided pursuant to Public Law 93-579 (Privacy Act of 1974), December 31, 1974,
for individuals applying for admissions to the National Fire Academy's Executive Fire Officer Program.
Authority - Public Law 93-498, 15 U.S.C. 301.44, U.S.C. 3101, 50 U.S.C. App. 2253, E.O. 12127 and E.O.
12148.
Purposes and Uses - The principal purpose of the information requested on this form will be used to select
candidates to the Executive Fire Officer Program.
Effects of Nondisclosure - Personal information provided on this form is given on a voluntary basis as is
participation in any training program. Failure to provide this information , however, may result in a delay in
processing your application.
Information Regarding Disclosure of Your Social Security Number Under PL 93-579, Section 7(b) Solicitation of the SSN is authorized under provision of E.O. 9397, dated November 22, 1943. The disclosure of
your SSN is voluntary and is only for recordkeeping purposes. If you do not provide your SSN. a number will be
assigned to you for recordkeeping purposes. The SSN is used as an identifier to match the person completing the
training with the correct master record in order to better assist you in obtaining certifications of completed
courses. The use of the SSN is necessary because of the large number of individuals who have identical names
and birth dates, and whose identities can only be distinguished by the SSN.
Paperwork Burden Disclosure Notice
Pubic reporting burden for this form is estimated to average 1 hour per response. Burden means the time, effort
and financial resources that you use to generate, maintain, retain, disclose, or provide information to us. Your
response to the collection is required to assist us in the applicant review and selection process. You are not
required to respond to this collection of information unless it displays a valid OMB control number. You may
send comments regarding this form including suggestions for reducing the burden to: Information Collections
Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW,
Washington, DC 20472, Paperwork Reduction Project (1660-0021). Please do not send your completed
application form to the above address. Use the return address provided below.
Application Instructions
1. Please type.
2. Please provide all information requested and be concise in your responses.
3. Mail the application to:
U.S. Fire Administration/National Fire Academy
National Emergency Training Center
Office of Admissions, Building I-216
16825 South Seton Avenue
Emmitsburg, Maryland 21727

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY

APPLICATION FOR ADMISSION

NATIONAL FIRE ACADEMY
EXECUTIVE FIRE OFFICER PROGRAM

NAME OF APPLICANT

O.M.B. NO. 1660-0100
Expires March 31, 2011

SOCIAL SECURITY NUMBER (Last four digits)

SECTION I - GENERAL INFORMATION
1. Please describe your organization fully in terms of functions or services provided and its annual budget.

2. Please describe your specific duties and responsibilities within the organization at an executive level, the number of employees you
supervise and to whom you report.

FEMA Form 119-25-5, MAR 08

PREVIOUSLY FEMA Form 95-22

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SECTION II - BRIEF ESSAY QUESTIONS
3. Describe your most substantial professional achievement and explain why you view it as such.

4. What goals do you expect to realize by participating in the Executive Fire Officer Program and how might achieving those goals enhance
your career?

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SECTION II - BRIEF ESSAY QUESTIONS (continued)
5. How do you expect your background, experience, and capabilities will contribute to the Program and to your fellow participants.

6. Please describe briefly the two most challenging management problems facing you on your job, explaning how they affect attainment of
your organization goals.

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