Basic Law Enforcement - Ogeechee Technical...

Updated: 01/24/11

Basic Law Enforcement Technical Certificate of Credit (TCC)

ADMISSIONS PACKET

www.ogeecheetech.edu 912.681.5500 or 800.646.1316

As set forth in its student catalog, Ogeechee Technical College does not discriminate on the basis of race, color, creed, national or ethnic origin, gender, religion, disability, age, political affiliation or belief, veteran status, or citizenship status (except in those special circumstances permitted or mandated by law). Penny Hendrix, Section 504/ADA Coordinator, Office 171E, 912.486.7211 / Kelli Waters, Title IX Coordinator Office 143H, 912-871-1885

Updated: 01/24/11

Dear Future Student,

We are excited that you have chosen Ogeechee Technical College to help prepare you for a bright future as a law enforcement officer. Your admission to our Basic Law Enforcement Certificate program is based upon the completion of several admission requirements.

Applicants must complete a two phase process. Phase I involves admission to Ogeechee Technical College. Phase II involves securing POST approval to attend the Law Enforcement Academy. Each will require a separate application process. Any student admitted to Ogeechee Technical College but not approved by POST will not be considered for the Law Enforcement Academy.

General Information:

• This program is offered in Evans County at the Law Enforcement Academy (Claxton, Georgia).

• Applicants must be at least 18 years of age in order to apply for admission to the Basic Law Enforcement TCC program.

• Applicants must possess a high school diploma or GED in order to be eligible to apply.

• An applicant will NOT be submitted to POST for acceptance into the program until ALL of the local admission requirements are fulfilled. Submitting any portion of the required documentation DOES NOT reserve you a spot in the program. It is also important to note, that completing all of the required admission criteria DOES NOT guarantee your admission into the program.

Estimated Costs: • Application Fee $20 • Tuition and Fees: $233 per credit hour + *$86 in fees • POST Application Fee $150 • Class Supplies: $100 • Other Costs:

o Physical $50+ o GAPS Fingerprint Check $52 o Background Check $165 o Uniforms $200 (average)

Black shoes/boots (rubber soles), black belt, khaki beige pants, official LEA polo shirt, workout clothes for physical training

o Class Supplies: 1 5’ binder and the Georgia Law Enforcement Handbook available in the OTC Bookstore

*Includes $35 Instructional/Technology Fee not covered by HOPE Grant. If eligible, the HOPE Grant will cover tuition and fees (with the exception of the Application and Instructional/Technology Fee) and give you up to a $100 book voucher to offset the cost of books.

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Documents contained in this packet: Phase I

• Application for Admissions: Basic Law Enforcement TCC Phase II

• POST Pre-service application • Additional Information: POST Pre-service application • Georgia Applicant Processing Service (GAPS) Information • PSI Background Check Information

Notary Public • Many documents will require a notary public to witness the signing of the

forms. Shelly Brinkley, Administrative Secretary, with the Law Enforcement Academy is a Notary Public. You may schedule an appointment by contacting her at [email protected] or via phone at 912.739.5367.

Physical Demands of the Program

Physical Ability: Tasks require the regular and sustained performance of moderately physically demanding work, typically involving some combination of climbing and balancing, stooping, kneeling, crouching, and crawling, and that generally involves lifting, carrying, pushing, and/or pulling of moderately heavy objects and materials (20-50 pounds) and occasionally heavier items (50 pounds or over).

Sensory Requirements: Some tasks require the ability to perceive and discriminate colors or shades of colors, sounds, odor, depth, texture, and visual cues or signals. Some tasks require the ability to communicate orally.

Environmental Factors: Performance of essential functions may require exposure to adverse environmental conditions, such as dirt, dust, pollen, smoke, temperature and noise extremes, hazardous materials, traffic hazards, bright/dim lights, firearms, explosives, violence, animals/wildlife, disease, or rude/irate customers.

If you have questions regarding disability services and available accommodations, please contact our Disability Resource Coordinator at 912.486.7211.

APPLICATION and FINANCIAL AID DEADLINES A Day program will begin Spring Quarter (April).

• Admissions: PHASE I and PHASE II DOCUMENTS o All items must be completed/submitted by March 1, 2011 for Spring Quarter. o Notification of completion of Phase I will be sent via mail and email as soon as

an applicant becomes eligible to move to Phase II. • Financial Aid

o Financial aid documents must be completed/submitted by March 14, 2011 for Spring Quarter.

Updated: 01/24/11

All law enforcement candidates must be able to complete the skills and abilities as listed below to be certified as a police officer in the State of Georgia:

Basic Skills for Law Enforcement Officer 1. Skill in comparing fingerprints from crime scene with those of suspect 2. Skill in using automated external defibrillator-AED 3. Skill in fingerprinting prisoners 4. Skill in operating camera to photograph prisoner, crime scene, crash scene, etc 5. Skill in documenting warrants in docket book 6. When Acquired: Skill in dusting and lifting fingerprints 7. Skill in collecting handwriting samples 8. Skill in sketching a crime scene or crash scene 9. Skill in casting impressions at crime scene (plaster, silicone, etc) 10. Skill in operating ratio in patrol car 11. Skill in measuring skid marks at crash scene 12. Skill in drawing collision diagrams 13. Skill in collecting physical evidence at crash scene 14. Skill in estimating vehicle speed using physical evidence and mathematical formulas, etc15. Skill in handcuffing a subject 16. Skill in restraining subject with device other than handcuffs 17. Skill in subduing subject resisting arrest 18. Skill in using chemical agents 19. Skill in using electrical control device (e.g. Taser) 20. Skill in using firearm 21. Skill in using baton to subdue subjects 22. Skill in protecting handgun while it is being attacked outside of holster 23. Skill in using pressure point control on resistive subject 24. Skill in using escort hold on resistive subject 25. Skill in striking resistive suspect with officers hands or feet (personal weapons) 26. Skill in protecting handgun while it is being attacked inside of holster 27. Skill in using a baton retention technique when baton is grabbed by suspect 28. Skill in controlling a suspect while both of you are on the ground 29. Skill in engaging in Emergency Vehicle Response in congested and open areas 30. Skill in conducting high speed pursuit in congested and open areas 31. Skill in operating a patrol vehicle

Updated:01/24/11

Basic Abilities for Law Enforcement Officer 1. Ability to administer CPR 2. Ability to administer First Aid 3. Ability to administer mouth to mouth resuscitation 4. Ability to administer emergency aid to control bleeding 5. Ability to administer aid to drowning victim 6. Ability to administer emergency aid for childbirth 7. Ability to administer emergency aid for choking victim 8. Ability to set priorities for action at accident scene 9. Ability to subdue an attacking person 10. Ability to defend self with hands only 11. Ability to run at least 250 yards to catch fleeing suspect 12. Ability to crawl under low obstacle (fence/gate/brush) to pursue a fleeing suspect and/or render aid 13. Ability to change direction quickly while pursuing a subject 14. Ability to pursue a suspect over trenches and small ditches 15. Ability to pursue fleeing suspect on foot around obstacle (cars, trees, alleys) 16. Ability to climb through windows in order to gain entry 17. Ability to climb through openings/crawl spaces, etc 18. Ability to drag unconscious victim from dangerous situations for at least 20 feet 19. Ability to climb over 4 foot fence to pursue a suspect 20. Ability to pursue suspect up and down 2 flights of stairs 21. Ability to stoop and/or bend to collect evidence 22. Ability to participate in physical training 23. Ability to pursue suspect over uneven terrain 24. Ability to stand continuously for more than four hours 25. Ability to physically push moveable objects other than vehicles 26. Ability to break through doors using force 27. Ability to pursue suspect by jumping over low obstacles 28. Ability to walk continuously for more than one-half of a work shift 29. Ability to search crime scene for evidence 30. Ability to interpret court order

Updated: 01/24/11

Additional Information

POST Pre-service application

Notary Public- The Peace Officer application requires that certain signatures be notarized. Do not sign any pages requiring a notary except in the presence of a notary. The Law Enforcement Academy and POST will not accept applications that are not notarized.

Page 2- Photo must be a passport picture. You can obtain a passport photo from most U.S. Post Offices, Walmart Photography Studios, and some Drug Stores’ photo development centers. All will charge a fee. Call ahead before going to ensure they provide service and inquire about the cost.

Page 5- You must bring in an original certified copy of your birth certificate. This means it must have the raised seal on it. Administrative personnel will make a copy for the application. (If you do not have an original certified copy of your birth certificate, you must bring in your valid Georgia Driver’s License and one of the other original documents listed on Page 5 along with appendix 9 which must be notarized.

Page 6- A copy of your high school diploma is required. If you choose to include your college degree(s) a copy of your diploma is also required.

Page 7- If you have served in the military, you must bring in the original Member 4 copy of your DD214. Administrative personnel will make a copy for the application.

- All explanations required for Page 8 must be on a separate page and must be signed.

Page 10- Read the first paragraph very closely as it emphasizes what you must list for criminal history.

Page 11- Fingerprints must be obtained through GAPS. A form detailing the process is included in the application packet. Fee of $52 is payable online with a debit card or a credit card or at the fingerprinting site with a money order or cashier’s check. CASH AND PERSONAL CHECKS ARE NOT ACCEPTED.

Physician’s Affidavit- Only a licensed physician can fill out and sign the form. Signatures of nurses, nurse practitioners, physician’s assistants, and other staff will not be accepted. For questions 1 and 2 of the affidavit, any answer other than “no” requires additional information from the physician. For question 3, any adverse mark must have recommendations included.

Georgia Peace Officer Standards & Training Council Pre-Service Application for Certification

Pg __ Of __ Initial ____

CERTIFICATION OF CANDIDATE – PAGE 1 Projected Academy: Projected Academy Start Date Notify POST via e-mail if actual start date is different from this projection. Candidate’s Last Name

Candidate’s First Name

Candidate’s Middle Name

Give suffix (such as Jr. , Sr., II, III, IV, V, etc.) :

Candidate’s Position Pre-Service Candidate for Peace Officer

Maiden Name

RACE

SEX/GENDER

Education (select highest level that documentation is provided for in this application) Social Sec#

Date of Birth (mm/dd/yyyy)

HEIGHT ft in

WEIGHT lbs

HAIR COLOR

EYE COLOR

Are you a citizen of the United States? Yes No

ACADEMY MAKING APPLICATION

ACADEMY PHONE# (AREA CODE) - NUMBER

( )- - NAME OF ACADEMY CONTACT (Agency Person Processing Application)

CONTACT PHONE# (IF DIFFERENT) (AREA CODE) - NUMBER ( )- - EXT

EMAIL ADDRESS OF ACADEMY CONTACT @

Effective July 1, 2008, candidates completing the POST requirements and training for certification will receive their certification via mail to their home address.

Checklist (Please check each block below to verify that a complete application is provided.) ___ Page 2 Agreement/Photo ___ Page 3 PH Release ___ Page 4 Verification ___ Page 5 Birth/Citizen

___ Page 6 Education ___ Page 7 Military ___ Page 8 Entrance Exam/LE Hist ___ Driver Hist

___ Page 10 Criminal History ___ Page 11 Printout/FPs ___ Page 12 Attestation ___ Physician’s Affidavit

___ Birth Certificate or other docs provided ___ Naturalization Papers. (both must be attached.) ___ Notarized/Written Statement required (see Appendix 9) ___ High School Diploma/GED/Homeschool Affidavit ___ Electronic Fingerprint Receipt for Georgia Applicant Processing Service

___ DD214 form ___ Discharge explanation ___ Entrance Exam Results ___ GCIC/NCIC Printout ___ Driver’s History



CANDIDATE AGREEMENT & PHOTOGRAPH – PAGE 2 Please read and sign in the presence of the agency head or authorized representative acknowledging your acceptance and understanding of this agreement. I, (FULL NAME OF CANDIDATE – First Middle Last), when approved for Basic Law Enforcement Academy Training, agree to obey all rules and regulations, and understand that I am subject to dismissal from the Training Academy for any infractions or failure to achieve the scholastic standard set by the Georgia POST Council. I further certify that I am in good health, physically fit, and of good moral character and release the Georgia Peace Officer Standards and Training Council, the Department of Public Safety, the Georgia Public Safety Training Center, the State of Georgia, and any other official associated or connected with the training academy for liability in case of illness or accident. I understand that I must satisfactorily complete a basic training course prior to performing the duties of a peace officer, according to O.C.G.A. §35-8-9. This application will be valid for 18 months only. If not certified by that time, a new application must be submitted according to POST Council Rule 464-3-.01. ________________________________________ Candidate Signature Date ________________________________________ Agency Head or Authorized Representative Signature

Place

Photograph Here



PERSONAL HISTORY RELEASE – PAGE 3 I do hereby authorize the review of and full disclosure of all records concerning myself to the duly authorized agent of the Georgia Peace Officer Standards and Training Council. The intent of this authorization is to give my consent for full and complete disclosure of the records of educational institutions; the records of the U.S. Department of Defense including any military records; financial statements and records wherever filed; medical and psychiatric treatment and/or consultation including hospitals, clinics, private practitioners, and the U.S. Veterans’ Administration; employment and pre-employment records, including background reports, polygraph examinations or reports, efficiency ratings, complaints or grievances filed by or against me and the records and recollections of attorneys at law, or of other counsel, whether representing me or another person in any case, either criminal or civil, in which I presently have or have had an interest. I understand that any information obtained by a personal history background investigation, which is developed directly or indirectly, in whole or part, upon this release authorization will be considered in compiling any report for the Georgia Peace Officer Standards and Training Council. I certify that any person(s) who may furnish such information concerning me shall not be held accountable for giving this information; and I do hereby release said person(s) from any and all liability, which may be incurred as a result of furnishing such information. A photo copy of this release form will be valid as an original thereof, even though the said photocopy does not contain an original writing of my signature. I understand that this information may be obtained through the use of this waiver at any time during which my registration or certification is maintained through the Georgia Peace Officer Standards and Training Council.

DATE OF BIRTH (mdyyyy)

MAIDEN NAME

PHONE NUMBER (AREA CODE) - NUMBER ( )- -

Social Security Number: Email Address @ ADDRESS: Street Apartment/Unit# City: State: Zip Code: -

____________________________________________ _________________ Candidate Signature (including maiden name) Date ____________________________________________ _________________ Notary Public Signature Date

Last Name

First Name

Middle Name



VERIFICATION/RECOMMENDATION/ACKNOWLEDGEMENT – PAGE 4

I have verified the information provided by the candidate contained in this application, and I am aware that it is my responsibility to provide POST with a complete and accurate application on behalf of my agency. My initials have been placed in the upper right hand corner on each page to signify my review of the information provided, and I accept responsibility for the veracity of this application. Based on my verification, this candidate has met the requirements of O.C.G.A. § 35-8-8. _________________________________________________ _______________________ Signature –Agency Employee Responsible for Verification Date

BACKGROUND INVESTIGATION

Copy of Background Investigation Attached

(FULL NAME OF CANDIDATE – FIRST, MIDDLE INITIAL, LAST) Date Candidate was interviewed: (mm/dd/yyyy)

Name of Interviewer (First Last)

The Background Investigator verified the following information with the appropriate authorities: - Education (High School & College) Yes No - Prior LE Employment & Certification Yes No Not applicable - Military Yes No Not applicable - Criminal History Yes No - Traffic History Yes No

Name of Background Investigator (First Last)

Date Background Investigation Completed (mm/dd/yyyy)

__________________________________________________________________________________ Signature of Person Conducting Background Investigation

ACADEMY DIRECTOR RECOMMENDATION

The candidate named in this application was found to satisfy the requirements of O.C.G.A. § 35-8-8, and is recommended by me for attendance to a Basic Law Enforcement Training Course and for certification upon successfully completing this training.

(NOTE: Once this application is approved a POSTFORM #2 authorizing the academy/school attendance will be issued. No person shall perform the duties of a peace officer until successful completion of the Basic Law Enforcement Training Course.)

“(a) No person required to comply with the certification provisions of this chapter shall be employed or appointed by any law enforcement unit without certification from the Council that the applicant has met the pre-employment requirements established in this chapter.” __________________________________________ _______________________ Academy Director or Designee Signature Date



BIRTH & CITIZENSHIP VERIFICATION – PAGE 5 Does candidate’s name match the name on their birth certificate? Yes No

If No, please list all of the names that candidate has had since birth and explain discrepancy (adoption, marriage, name change, etc). (Documentation for a name change for anything other than marriage MUST be attached.)

Check here if name change documentation is attached

Names: (List chronologically with most recent first): Name: Used from (YR) to (YR)

Name: Used from (YR) to (YR)



Explanation(s) for name changes:

Was Candidate born in the United States? Yes No

Country of birth if other than U.S.: City: State:

Was the candidate a U.S. military dependent at the time of birth? Yes No

Is the candidate a naturalized citizen? Yes No NOTE: If naturalized, a certified copy of the naturalization papers OR a copy of their U.S. passport must be submitted.

ATTACHMENTS Attached to this page is a copy of the candidate’s certified birth certificate: YES NO If NO, attached is a copy of the candidate’s valid Georgia Driver’s License and: (must have at least one of the following documents – check the ones that are attached)

Baptismal Record (w/full name & date of birth) Draft Card (w/full name & date of birth) Court Records (w/full name & date of birth) Passport (w/full name & date of birth) Citizenship Papers (w/full name & date of birth) Armed Forces Discharge Paper (DD214) (w/full name & date of birth) Certified Copy of School Records (w/full name & date of birth)

IMPORTANT NOTE:If any of the above documents are used for this verification, the documents must show the full name and date of birth of the candidate. In order to establish the place of birth, the candidate must submit a signed & notarized statement (Appendix 9) indicating that the candidate is a United States citizen if documents other than a birth certificate are furnished . Included in this statement must be the place, date and country of birth.

If the candidate is a naturalized citizen, a certified copy of the naturalization papers or a copy of their U.S. passport and a completed Appendix 9 must be submitted.

Appendix 9 attached (Appendix 9 is the required signed & notarized statement listed above)

Certified copy of naturalization papers or U.S. passport is attached



EDUCATION – PAGE 6 Please attach High School Diploma or GED or Home School Affidavit to this page.

Candidate graduated high school from:(select one)

(Important Note: School must have a state, regional, or national accreditation that POST accepts – see www.chea.org for acceptable accrediting agencies.)

High School Name: Location of High School (City/State): Year Graduated (yyyy) H.S. Phone # ( )- -

COLLEGE Candidate received their highest college degree from: Year Graduated w/highest degree (yyyy)

The degree was a/an:

Note: If candidate wishes to have their college degree recorded in their profile, a copy of their diploma or a certified copy of their college/university transcript can be attached in addition to their high school diploma.

Check here if candidate has ALSO attached a college diploma/transcript for their profile.

List colleges/universities attended or obtained a degree from (list colleges/universities): (Use and attach appendix 4 for additional degrees obtained and/or colleges attended) College/Univ: Attended from (mo/yr to mo/yr): to

Did not obtain degree Obtained: Associate’s Bachelor’s Master’s Doctorate degree. College/Univ: Attended from (mo/yr to mo/yr): to

Did not obtain degree Obtained: Associate’s Bachelor’s Master’s Doctorate degree. College/Univ: Attended from (mo/yr to mo/yr): to

Did not obtain degree Obtained: Associate’s Bachelor’s Master’s Doctorate degree.

* IMPORTANT NOTE: If the candidate obtained their diploma from a correspondence school or received a diploma via the internet, the hiring agency will need to check & attach accreditation of the school. Schools issuing diplomas must be accredited by one of the POST accepted accrediting agencies (see www.chea.org for acceptable accrediting agencies).



MILITARY – PAGE 7

PLEASE ATTACH YOUR MILITARY DISCHARGE OR DD214 HERE. (DD214 (Member 4 form version) must indicate type of discharge.)

Did this candidate serve in the military? Yes No (If “NO”, go to the next page. If Yes, complete this page.)

Candidate served in the (check as apply): Air Force Army Coast Guard Marines

Navy National Guard Reserves – Give Branch

Other Department of Defense service – list IMPORTANT NOTE: If the candidate recently served or is currently serving in the reserves, it is acceptable to attach a letter from their current military reserve commander regarding their service record.

Candidate’s dates of enlistment:

FROM (MONTH/YEAR) TO (MONTH/YEAR)



Was candidate’s CHARACTER OF SERVICE/DISCHARGE honorable? Yes No (If Yes, go to the next page. If No, candidate’s character of service was listed as (choose applicable one from pull down menu below):

A brief explanation regarding candidate’s character of service/discharge must also be attached to this page (providing details for the reason for this character).



ENTRANCE EXAM & LE EMPLOYMENT HISTORY – PAGE 8

ENTRANCE EXAM (POST FORM EE) is attached to this page.

LAW ENFORCEMENT CERTIFICATION HISTORY

1. Has the candidate ever been certified or previously submitted an application to GA Post Council? Yes No

2. Has the candidate ever been certified as an officer in another state? Yes No (If YES, list state & certification #’s. Use appendix 6 for additional listings if necessary.)

STATE (Ex. GA): CERTIFICATION#

STATE (Ex. GA): CERTIFICATION#

If the candidate answers “YES” to #2 above, POST requires written proof from the other state’s POST Council or equivalent that the officer’s certification in that state is in “good standing.” See Reference Manual for more details on “Good Standing”. (Check box below to verify that proof of good standing is attached.)

3. Has the candidate ever been denied an application for certification for a law enforcement professional position (i.e. police, jail, communications, probation, parole, etc) in GA or another state?

Yes No N/A If YES, a written signed explanation must be provided. Check box below if attached.)

4. Has the candidate’s certification ever been disciplined or sanctioned in another state? YES NO N/A (If YES, provide a written signed explanation & check box below if attached.)

Attachments to this page:

Proof of Officer’s “good standing’/certification status (needed for states other than Georgia ONLY)

A written & signed explanation of the officer’s denial.

A written & signed explanation of the officer’s discipline or sanction.

LAW ENFORCEMENT EMPLOYMENT HISTORY Please list law enforcement agencies that you have worked for in chronological order (with most recent first). See appendix 6 for additional pages for employment history if necessary.

Agency Name: State: Employed from (mo/yr) to: Position held: Reason for leaving:



EQUIVALENCY RATING FOR PRIOR LAW ENFORCEMENT EXPERIENCE

POST response regarding this rating is being requested with this application. (IMPORTANT NOTE: If an equivalency rating is desired, see Appendix 12 for form/details. Additional processing time may be required if an

equivalency rating is requested with the submittal of this application. Prior submittal is suggested.)

POST response regarding this rating is attached with this application.



Certified Driver History – PAGE 9

Attached is a certified copy of candidate’s GA driver’s history or printed from GCIC

Attached is a certified copy of candidate’s driver’s history from another state

IMPORTANT NOTE: Certified copy of an individual’s driver’s history must be the approved/accepted version by the state’s department that governs driver’s licenses and driver histories.

Candidate has possessed driver’s licenses in what states in the past 10 years: (Check what applies)

Georgia Driver’s License ONLY during past 10 years Military Driver’s License ONLY during past 10 years Military Driver’s License (From (yr) To (yr) )

States other than Georgia (list years and states below) YEARS: From (yr) To (yr) State: From (yr) To (yr) State: From (yr) To (yr) State: From (yr) To (yr) State: From (yr) To (yr) State: From (yr) To (yr) State:

Has candidate ever been given a traffic citation? Yes (If Yes, complete this section.) No (If No, go to next page.)

Has candidate received more than three citations during the past five years? Yes No

Has candidate ever had their license suspended? Yes (If yes, check which reason and give year) No

Year: DUI/DWI Points Insurance related Other If other, give brief reason below:

Reason: List any traffic citation received during the past five years. Use Appendix 2 if necessary. DATE OF CITATION

TRAFFIC VIOLATION

ISSUING AGENCY

DISPOSITION

DATE OF CITATION

TRAFFIC VIOLATION

ISSUING AGENCY

DISPOSITION

DATE OF CITATION

TRAFFIC VIOLATION

ISSUING AGENCY

DISPOSITION

DATE OF CITATION

TRAFFIC VIOLATION

ISSUING AGENCY

DISPOSITION

DATE OF CITATION

TRAFFIC VIOLATION

ISSUING AGENCY

DISPOSITION

DATE OF CITATION

TRAFFIC VIOLATION

ISSUING AGENCY

DISPOSITION

Candidate’s Last Name Information verified by Candidate: _______________________________________________________ Candidate’s Signature



CRIMINAL HISTORY – PAGE 10 Please read the following information carefully before completing the next pages.

Pursuant to Title 35, Chapter 8 of the Official Code of Georgia Annotated and the Rules of the Georgia Peace Officer Standards and Training council, each applicant is required to disclose EACH AND EVERY arrest and/or citation which the applicant has received, along with the disposition of EACH AND EVERY arrest and/or citation. Dispositions include, but are not limited to, dismissal, placement on a dead docket, nolle prosequi, finding or verdict of guilty or not guilty, plea of guilty, plea of nolo contendere, treatment under the First Offender Act, expungement, sealed, pardoned, or bond forfeiture. NOTE: Failure to provide all requested information (including any intentional or unintentional omissions) may result in the rejection/denial of the application.

Has the candidate lived only in the state of Georgia: Yes No

Has the candidate ever been arrested? Yes If Yes, complete this section. No If No, go to the Next Section.

Has the candidate ever been convicted of a felony? Yes No

Has candidate ever been charged with a crime of domestic/ family violence? Yes No (If YES, a copy of the police incident report and the court disposition regarding the arrest must be attached.)

Is the candidate currently or ever been subject to a qualifying protection order (temporary or federal) prohibiting the possession of a firearm or ammunition? Yes No (If Yes, submit copy of the order.)

List all felonies first. List all other charges in chronological order (with most recent first). Use Appendix 1 if necessary. DATE OF ARREST m/d/yyyy

ARRESTING AGENCY

CHARGE (pick from list, if not on list provide below) If not on list, give charge: DISPOSITION: If OTHER, give disposition below:

CONVICTED: Yes No Check all that apply:

Fine Amount:

Probation Time(mos/yrs):

Incarceration Time(mos/yrs):

Community Service

DATE OF ARREST m/d/yyyy

ARRESTING AGENCY

CHARGE (pick from list, if not on list provide below) If not on list, give charge: DISPOSITION: If OTHER, give disposition below:

CONVICTED: Yes No Check all that apply:

Fine Amount:

Probation Time(mos/yrs):

Incarceration Time(mos/yrs):

Community Service

Attachments: Police Incident Report Court Disposition Signed/Notarized Statement re: incident

Candidate’s Last Name Information verified by Candidate: _______________________________________________________ Candidate’s Signature



GCIC/NCIC PRINTOUT/FINGERPRINT RESULTS - PAGE 11 State law requires a fingerprint check to be conducted by both GCIC and NCIC for candidates for certification.

Attached Electronic Fingerprint Results Receipt for Ga Applicant Processing Service Please provide Appendix 13 which is a separate document from this application to the candidate to assist in using the GAPS fingerprinting service. For more details see Georgia Applicant Processing Service at web site http://www.ga.cogentid.com/index.htm.

CANDIDATE ATTESTATION

I have personally reviewed this application regarding ALL INFORMATION provided by me including my criminal and driver history. I attest and affirm that the information provided in this application including my criminal and traffic history is complete and correct to the best of my knowledge. I further understand that any act of omission may be grounds for denial of this application for certification as a peace officer (O.C.G.A. §35-8-7.1) and could result in criminal prosecution (O.C.G.A. §16-10-20). Each page is signed by me confirming verification of the data on that individual page. I understand that any page not signed and verified by me could result in a delay of processing of this application.

Last Name

Social Sec#

First Name

Date of Birth (mm/dd/yyyy)

Middle Name

Suffix:

________________________________________________ ________________ Applicant Signature (Sign Full Name) Date

AGENCY ATTESTATION

As the agency head (or designee for the agency head), I have reviewed this application regarding ALL INFORMATION provided by the candidate including the criminal and driver history. I attest and affirm that the information provided in this application including the criminal and traffic history are within the hiring standards of our department and adhere to the requirements set forth by the Georgia Peace Officer Standards Training Council. Print Name of Agency Head (or designee) ____________________________________________ ________________ Agency Head (or designee) Signature Date _______________________________________________ ________________ Notary Public Date Notary Seal

Here



Physician’s Affidavit – PAGE 1 of 3

PHYSICIAN’S INSTRUCTIONS: Please complete this form and answer all questions related to your medical examination of this candidate. Do the following steps:

1. Review the candidate’s job duties/responsibilities. This candidate is applying to become a certified peace officer and will be required to meet the relevant job demands and working conditions of a peace officer in Georgia.

2. Complete the patient information at the bottom of this page and then conduct your physical exam.

3. Review the patient’s Medical and Physical History. A Report Form may be provided to you by the candidate or you may use the form commonly used in your medical practice.

4. Answer all questions by checking the appropriate block on each page and providing any comments necessary for the hiring agency’s assessment.

5. SIGN & DATE on the appropriate page of this form and provide your address & phone #. (Please note that this exam must be conducted by a licensed physician or osteopath, and the form signed by a licensed physician or osteopath only. (Forms signed by other personnel such as nurses, nurse practitioners, physician’s assistant, or other staff will be rejected.)

6. Give all forms to the candidate for return to the hiring agency.

This candidate, if certified, will have the prerequisites necessary to gain employment at any law enforcement agency in the State of Georgia, including but not limited to the current place of employment. Peace officers are charged with the responsibility of enforcing criminal laws and are subject to deal with violent individuals and situations. Officers are often required to defend themselves and others from physical attacks, subdue resisting individuals, and make decisions under stress concerning the use of deadly force. These types of positions generally require a high level of physical capability. O.C.G.A. §35-8-8 and POST Rule 464-3-.02 require that candidates be found, after examination by a licensed physician or surgeon, to be free from any physical, emotional, or mental conditions which might adversely affect his/her exercising the powers or duties of a peace officer. Please note that your answers are intended to provide the hiring agency with the most useful information possible to base an employment decision, confirm to the Georgia Peace Officer Standards and Training Council that this candidate meets the requirements set forth in POST Rule 464-3-.02, and in your medical opinion, this candidate is capable of safely completing the required training and safely performing the necessary job duties.

Name of Agency Contact (Agency Person Processing Application)

Contact Phone# (Area Code) - Number ( )- - EXT

EMAIL ADDRESS OF AGENCY CONTACT @

SECTION 1: TO BE COMPLETED BY LICENSED EXAMINING PHYSICIAN

DATE OF BIRTH (mm/dd/yyyy)

Suffix:

Maiden Name

HEIGHT ft in

WEIGHT lbs (without shoes & coat)

SEX:

This individual is a candidate for Peace Officer Certification in Georgia.

Social Sec#

Last Name

First Name

Middle Name



Physician’s Affidavit - PAGE 2 of 3 1.) In your opinion, does the candidate have, or is the candidate likely to develop, any physical symptoms or limitations that could impair performance in this position?

No Proceed to question 2

Indeterminate Describe additional tests or information required prior to making final determination.

Yes Describe the impact of these limitations including the following criteria: • Job functions affected

• Nature & degree of severity

• Duration of impairment (if intermittent or temporary)

• Likelihood(s) associated with this impact

2.) In your opinion, could the candidate’s performance in this position result in a risk to the health and safety of the candidate or others?

No Proceed to question 3

Indeterminate Describe additional tests or information required prior to making final determination.

Yes Describe the impact of these limitations including the following criteria: • Specific job duties/functions and/or working conditions that precipitate the risk:

• Nature & severity of potential harm:

• Impact of harm on self and/or others:

• Likelihood(s) associated with this risk:

• Imminence and duration of the threat;

Please describe any means, devices or work restrictions that could reduce or eliminate any identified risks to a level not significantly greater than that posed by the average candidate. Include the manner in which the accommodation needs to be implemented, maintained, and monitored; any side effects or risks associated with the accommodation; and a revised estimate of the candidate’s viability in this position if it is implemented.



Physician’s Affidavit - Page 3 of 3 3.) In summary, what is your overall evaluation of the candidate’s ability to safely perform the duties of this position? (choose one below)

This candidate has no physical, emotional, or mental conditions that might adversely affect his/her ability to perform the duties of a peace officer or take part in training programs relative to law enforcement. Comments:

This candidate has no physical conditions that might adversely affect his/her ability, but there are some concerns that should be addressed regarding one or more emotional or mental conditions that could adversely affect their ability. (Please state recommendations on how to address here.) Comments:

This candidate has no emotional or mental conditions that could adversely affect their ability, but there are some concerns that should addressed regarding one or more physical conditions that could adversely affect their ability. (Please state recommendations on how to address here.) Comments:

This candidate has one or more physical , emotional, or mental conditions that could adversely affect their ability that need to be addressed. (Please state recommendations on how to address here.) Comments:

SIGNATURE OF LICENSED EXAMINING PHYSICIAN (required)

EXAMINING PHYSICIAN’S NAME (printed)

____________________________________________________ Last First

DATE (m/d/yyyy)

ADDRESS OF LICENSED EXAMINING PHYSICIAN’S PRACTICE ________________________________________________________________________ Street ________________________________________________________________________ City, State, Zip

Phone: Area Code+Number ( )

SECTION 2: ACADEMY DIRECTOR’S ASSESSMENT (TO BE COMPLETED BY ACADEMY DIRECTOR OR DESIGNEE) Based on the information provided by the physician and the candidate, it is my belief that the candidate meets the state standards for this position and can safely perform the essential job demands of the position for which they are being trained. If a reasonable accommodation is necessary for this individual and the state standards are still met, I have attached a letter explaining the necessary accommodations. SIGNATURE OF ACADEMY DIRECTOR OR DESIGNEE (required)

DATE

Accommodation Noted:. Check here if a letter from academy director giving details of accommodation is attached (required). This letter indicates that the candidate needs a reasonable accommodation which can be implemented without undue hardship to the agency & still meets state standards.

Georgia Applicant Processing Service (GAPS) Information

The Georgia Crime Information Center (GCIC) is responsible for processing fingerprint based criminal history record checks for employment/licensing purposes. In an effort to provide more timely responses, GCIC has partnered with Cogent Systems for the implementation of the Georgia Applicant Processing Service (GAPS). GAPS provides agencies submitting fingerprint cards for employment record checks with the option to have applicant background checks processed electronically. This process will provide timely search results and decrease rejections due to poor fingerprint quality of inked fingerprint cards.

Fixed GAPS offices will be located throughout the state so that GA residents will not travel more than 25 miles to a GAPS location for fingerprinting services.

Search results & criminal history records or “rapsheets” will be available for the agency to retrieve directly from the GAPS website within 24-48 hours after the applicant is fingerprinted and the transaction submitted to GCIC. A service fee is charged by the vendor, but fingerprint checks which are authorized for an FBI check may receive a reduced fee for electronic submissions.

Pre-Service candidates must submit fingerprint results with their application to meet the state requirements for attendance to a basic law enforcement academy. The following steps must be completed by the candidate using GAPS:

Step 1: Go to the website: www.ga.cogentid.com to determine the nearest GAPS location by looking under the heading “GAPS Print Site Locations.” Then click on “Print Locations & Hours” to find a location. Also, click on “What to Bring” to know what you will need.

Step 2: Next, go to the header, “Registration”, & click on “Single Applicant Registration.” This will begin your registration & payment process.

Step 3: Complete the web form with your personal data and payment information. Please use the following information for the fields – Reason, ORI/OAC, & Verification Code in this web form: Reason: POST Pre-Service Student ORI/OAC: GAGSP0007 (Please note that this field is case sensitive so use capital letters. The three digits before the “7” are zeros.) Verification Code: gpostcouncil

(Please note that this field is case sensitive so use lowercase letters.) Step 4: Print Step 4 on the screen to attach to your application. It should have at the top – Applicant Registration, Step 4 – Registration Complete, Thank you for Registering. You will need to keep a copy for your records also.

Step 5: Go to the GAPS location at your scheduled time & get fingerprinted. The GAPS location will provide the necessary fingerprinting service. Please note that it takes a minimum of 48 hours for POST Council to review the results. In some instances, it may take longer. Prints may be rejected for a variety of reasons by the FBI or GBI such as characteristics of low quality. These types of rejections are not common. If this occurs, a request for a second submission by the FBI may occur. See Cogent System information for have to handle if rejected and if costs apply. When results are available to POST staff, the results will be printed and attached to your application for completion of the POST application process. Please do not contact POST directly regarding the status of your prints. You will need to direct all questions to the academy that is submitting your application. If you need further assistance with the GAPS service, you can call the GCIC Helpline at (404)-244-2639 –“OPTION 2” or via e-mail at [email protected] .

©

Pro

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The fee fo

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After PS

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backg

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w

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three to

five days. D

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Call PS

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To

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back

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Pro

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do

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STEP

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• Access o

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then

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After co

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