Use this form to update personal or organization information, fitness level, training, qualifications or experience (white unshaded areas are required).	Date of Update:
SECTION 1 – Person/Organization Information (record only changed information)
Person ID:	Last Name:	First Name:	Middle Initial:
Job Title:	Employment Status:	Full-time Employee	Emergency Firefighter
Organization:	State-NWCG: VA-VAS	Org Level 1: DOF	Org Level 2 (Unit):	Org Level 3 (County):	Org Level 4:
Home Address:
City:	State:	Zip:
Home Phone:	Work Phone:
Cell Phone:	Work Phone 2:
E-mail:	Birth Month/Day:
Height:	Weight:	Clothing Size:	Medications:
Emergency Contact (*Mandatory):	Name:	Relationship:
Cell:	Home:	Work:
SECTION 2 – Fitness
Fitness Level:	Arduous	Moderate	Light	None
Certifier:	Effective Date (omit for None):
SECTION 3 – Task Books in Progress
Qual	Risk	Date Issued	Issuer	Date Completed	Comments
SECTION 4 – Refresher Training
Course	Risk	Date Completed	Instructor	Location	Hours	VDOF Employee Print
SECTION 5 – Training
Course	Risk	Date Completed	Score	Instructor	Location	Hours	Comments
SECTION 6 – Qualifications
Type (JOB/TRN/SKILL)	Qual	Risk	Effective Date	AD	Compact	Qual Level (Natl, State, Local)	Priority	VDOF Employee Print