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CAL FIRE 600a (Revised 4/2012) EMQ NO: (OSHPros Use Only) CAL FIRE-200 Needed PLEASE COMPLETE ALL 4 PAGES AND PRINT YOUR NAME ON EACH PAGE, SIGN AND DATE THE CERTIFICATION ON THE LAST PAGE Permanent Employment Status: (Check one) Limited Term No Separation Limited Term New Hire Reinstatement Retired Annuitant Other: Seasonal Returning Limited Term Returning After Separation Permanent New Hire Date: SSN: Last Name: First Name: Mailing Address: City: Seasonal New Hir.

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