GREENECOUNTY PeaceOfficerBasicTraining Application...a GREENECOUNTY “Sess CAREER CENTER”...

7~GREENE COUNTYCAREER CENTER

GREENE COUNTYPeace Officer Basic Training

Dear Academy Applicant:

Welcometo the field ofLaw Enforcement! It is our pleasure to provide you with information on the PeaceOffice Basic Training course offered through the Greene County Career Center in Xenia, Ohio. We lookforward to traveling with you on your journey into the exciting, yet demanding, arena of police work.Enclosed please find our information/application packet for the upcoming academy course offerings for2021-2022.

Please feel free to contact the program at Greene County Career Center at 937-372-6941, and speak witheither myself (extension 1553) or Tracey R. Cassel (extension 1551) if you need additional assistance. Weencourage you to visit our website at www.greeneccc.com. You will find academy information, relatedlaw enforcementlinks and general information on financial aid and other services provided by the GreeneCounty Career Center.

The Peace Officer, Basic Training program is eager to put you on the path to realize your dreams ofbecoming an Ohio Peace Officer.

Sincerely,

MichaelHildSr,

Michael Hild Sr., Commander

Greene County Career Center

Greene County Peace Officer Basic Training Academy

The Greene County Criminal Justice Training Academy (GCCIJTA)strives for professional distinction inproviding state-of-the-art law enforcement training. All training at GCCJTA adheresto the standards setforth by the Ohio Attorney General’s office and the Ohio Peace Officer Training Commission. Ourinstructors come from noted regional law enforcement agencies and provide infinite years of lawenforcement experiences and intuition. Greene County Criminal Justice Training Academyis honored tobe partnered with area law enforcement agencies in the form of an Advisory Board and resource bank ofelite instructors and trainers wholead by example.

Our academyis approximately 845 hours whichsets our standards above the minimum state requirementof 740. Ourtraining offers the Basic Peace Officer course and the followingcertifications:

¢ Oleoresin Capsicum (OC) Certificatione ASPCertification

¢ Taser (User Certification)e Single Officer Response to an Active Shooter

Recruits are responsible to meet all scheduled training hours and provide their own transportation to thetraining sites. Attendance is mandatory for all class sessions. The program of training includesclassroom, simulation and field training, Thefinal classroom dateis subject to change. The majority ofthe training will take place at Greene County Criminal Justice training sites; the rest will be at locationsaround Greene County.

Before submitting your application, please evaluate your personal and business commitments andresources, Compliance withall of the rules and policies set forth by the Academy are mandated. Absencefrom classes must be madeupat the student’s expense. Attendance and participation inall facets oftrainingis compulsory and failure to act in accordance with these standards will result in a request for yourresignation or dismissal from the academy.

Revised 08/17/202

SWORNOFFICERS:

Persons whohold a current oath of office with any Ohio law enforcement agency are automatically eligiblefor the Basic Police Academy.¢ Aphysical assessmentandoral interview are required.e Verify physicalfitness to safely functioninall phasesofthe academy’s strenuous training (verifiedby a licensed physicianto include disability, chronic illness, pregnancy, etc.)

OPENENROLLMENTRECRUITS

Those applicants whoare notaffiliated with a law enforcement agency must meetthe following minimumstandards:

e Have a valid Driver’s License¢ Have NO Felonyconvictions, warrants or investigations pendinge Have NO conviction for any offense stemming from a domestic violence charge, this includesguilty or no contest pleas to lesser charges whenthe original charge was domestic violenceor drugcharge.¢ Have NO convictions for any drug offense¢ Bein violation of Ohio’s Child Support Enforcement Lawse Becertified by a licensed physician as able to participate in all phases of the academy’s strenuousand stressfultraining (includes disability, chronicillness, pregnancy,etc.)¢ Successfully pass the entry level physical fitness assessment at 15% of the OPOTA academycompletion standard

It is strongly recommended that openenrollmentapplicants have previous knowledge or experience in thecriminaljustice field. Applicants will be asked in an oral interview how they have prepared themselves forentrance into the Basic Police Academy, and preference will be given to candidates who can demonstrateappropriate preparation.

Training Equipment and Uniforms

e Khaki pants/slacks¢ Pens, paperandatleast four three ring large notebook binder¢ Duty belt with /evel two holster and handcuff case with onepair of handcuffs, key, keepers orbeltstays, ammo pouches, ASP baton and holder*

—

Lists oftraining equipment and suggested types and vendors will be supplied following the physicalassessment, oral review board, and your acceptance into the academy. .¢ Firearms will be a 9mm, or .40 caliber and must be approved by the Academy Commander.

Revised 02/21/17.

3

Academy Conduct

All recruits, instructors and personsassociated with the Greene County Criminal Justice Academy willdisplay professional, mature and respectful behavioratall times. The Law Enforcement Code of Ethicsmust be adhered to as of Day One ofthe Academy. Any disruptive, disrespectful or unsafe behavior willnot be tolerated and couldresult in disciplinary actionto include dismissal from the academy with no refundof monies paid. Academyrecruits and personnel shall adhere to the guidelines and policies set forth in theStudent Handbookandwill be requiredto sign a statementofunderstandingprior to beginning the academy.

Recruits are required to follow standards of personal appearanceand hygiene:

o Hair for Men-military or tapered hair, off of the ears and no longer than collar lengtho Hair for Women-if longer than shoulder length, must be pinned up or otherwise fastenedsecurely to head

oO No afros, unless short and neatly barberedoO No unusualhair dyes permittedo Nobraids, cornrows, etc. in the hair, except where braided in order to fasten securely to

the head (womenonly)©o No bandanas, hats or do-rags will be worn during classroom instruction© Menare to be clean-shaven, with no beards, goatees or long sideburns. A mustache may

be wornso long as the ends of the mustache do not extend past the ends of the upperlip.oO Nofacial jewelry of any kind is permitted, including tongue piercings. No earrings arepermitted for men or women. There are to be novisible body piercings anywhere else onthe body; all jewelry (with the exception of wedding ring) is to be removed before thephysical contact portionofthe training begins.

o All tattoos must be covered, particularly those ofa vulgaror offensive nature. Ifthe tattoosare in an area that cannot be covered,it is highly recommendedthatthe individual considerhaving them removed.

oO Student in the academy must present a clean, neat, professional appearanceatall times.Clothing may not havestains, tears or holes, and will be washed and wrinkle free.

o Students will not wear excessive cologneor perfume.o Beginning withthe first day of class, students will be required to keep a typed notebook,

to be submitted every month for inspection and grading.

Cost and Financial Assistance

Tuition is payable either up front, in a paymentplan, throughfinancial aid assistance, or a combination ofself-pay and financial assistance. All financial arrangements and/or fees must take place at least twoweeks prior to the starting date of the academy.Failure to comply with deadlines will preventyou from participationin the academy. After enrollment and the beginningofthe academy,failure to meetscheduled payment dates will cause youto be terminated from the academy with no refund of moniespaidto date. Recruits sponsored and funded by an agency, must provide a letter of intent or purchase order oncompanyletterhead. Please contact Mr. DeLange, Financial Aid Advisor, at [email protected] or937-372-6941 ext. 2308 with questions.

Revised 08/17/204

Physical Fitness Training

All prospective academyrecruits will be required to pass a Pre-Academy Physical Fitness Assessment priorto beginning academytraining. Please review the Pre-AcademyPhysical Fitness Standards based on the15" percentile of the Cooper Fitness Standards from the Ohio Peace Officer Training Commission. Ifyoufail to meet the Pre-Academy Physical Fitness Standards, youwill be eliminated from the process,

Physical conditioning and the successful passing of the Final Physical Fitness Assessmentat the end of theacademy are compulsory. Please review the Final Physical Fitness Assessment Standardsbased on the50"percentile of the Cooper Fitness Standards from the Ohio Peace Officer Training Commission. Ifyoufail to meet the Final Physical Fitness Standards, youwill not be abletosit forthe state exam and mustrepeat the entire academy. Although academy staff will condition eachrecruit during the academy,all areencouraged to begin anexercise regimen prior to, during, and after the academy.

See Fitness Standards Table below.

Ohio Peace Officer Basic Training ProgramPhysical Fitness Standards

(50Percentile*)Age and Gender Minimum Scores

aseaaeny Final (50") Pre-Academy (15") Final 60")cast

Males (<-29)

|

Males (<-29) Females (<-29) Females (<-29)Sit-ups (1min) 32 40 23 35Push-ups (1 min)

|

19 33 9 181.5 Mile Run 14:34 11:58 17:49 14:07Males(30-39)

|

Males (30-39) Females (30-39)

|

Females (30-39)Sit-ups (1min) 28 36 18 27Push-ups (1 min)

|

15 27 7 14‘| 1.5 Mile Run 15:13 12:25 18:37 14:34Males(40-49)

|


|

Females (40-49)Sit-ups (1min) 22 31 13 22Push-ups (1 min)

|

10 21 5 1]1.5 Mile Run 15:58 13:11 19:32 15:24Males(50-59)

|


|

Females (50-59)Sit-ups (Imin) 17 26 7 17Push-ups (1 min)

|

7 15 4* Modified 13* Modified1.5 Mile Run 17:38 14:16 21:31 17:13Males (60+)

|

Males (60+) Females (60+) Females (60+)Sit-ups (min) 13 20 2 8Push-ups (1 min)

|

5 15 1* Modified 8* Modified1.5 Mile Run 20:12 15:56 23:32 18:52 __| *Based on, the Cooper Institute, Physical Fitness Specialist Course and Certification. Our instructors provide individualized support services inthe areaoffitness, goal setting, nutrition and exercise so each recruit can focus on meeting personal and OPOTA standards. ‘

Revised 08/17/205

aGREENE COUNTY“Sess

CAREER

CENTER”

FULL-TIME PROGRAM APPLICATION INSTRUCTIONSAdult Education Division

Before You Begin:A. All Full-Time Adult Education programs require the student to have completed their high school education. Students must submit acopyoftheir high schooldiploma,high school transcript or evidence of GED completion at time of registration,

B. Processing of Full-Time Program Applications may take several days. To ensure that you are accepted into one of our Full-TimePrograms, we encourage youto start the application process today.

Ohio Basic Peace Officer Basic Training Academy Applicants: Contact CommanderMike Hild at (937) 426-6636, ext. 1553 or Tracey R.Cassel, ext. 1551 to arrange for a personal meeting to review the application processforthe Ohio Basic Peace Officer Basic Training Academy.

Application Process:

Step 1: Completeall of the personalinformation located on the first pageofthe Full-Time Program Application.

Step 2: Completeall of the financialinformation on the second page ofthe Full-Time Program Application.

ifyou are applying for Pell Grants or Financial Aid. you must:A. Apply online at www.studentaid.ed.gov to obtain your FSA ID.B. Complete the Free Application for Federal Student Aid (FAFSA)online at www.fafsa.ed.govC. Youwill need to use the Federal School Code for Greene County Career Center: 016861D, Arrange to meetwith the FinancialAid Office priorto the first day of class.

if you will be attending one of our Full-Time Programs through WIA, BVR, TAA, VA, you must:A. Contact the appropriate agency:

i. Bureau of Vocational Rehabilitation (BVR) at (800) 686-9263.ii. Departmentof Jobs and Family Services Trade Adjustment Assistance Office (TAA)in the county of yourresidence. In Greene Countycall: (937) 562-6151,iii, Ohio MeansJobsin the county of your residence,

Greene County: Call GreeneWorksat (937) 562-6565Clark County: Call WorkPlusat (937) 327-1961Montgomery County: Call The Job Centerat (937) 496-6720Warren County: Call Workforce One at (513) 695-1130B. Bring Agency ApprovalLetter and meetwith ourFinancial Aid Office prior to the first day of class.C. VA Applicants ~ Please contact the Veteran's Administration directly and meetwith Becky Bond, 937-372-6941, ext, 204prior to the first dayofclass.

if you are going to be sponsored by your employer. you must:A. Bring a letter from your employer on companyletterhead prior to the first dayofclass stating and turninto the Bursar’soffice:

i. The program that you areeligible to enroll in.ii, The amountthe employer agreesto remit towardstuition,iii. Signed by a company authorizing agent,

Ifyou are going to be a “Self-Pay”, you must:A. Paythe entire amountofthe tuition for the term priorto the first day ofclass,

ORB. Arrange a paymentplan with the Bursar’s Office priorto the first day ofclass.

Step 3: Complete the Authorization To ReleaseInformation onthethird pageofthe Full-Time Program Application,

Step 4: Bring the completed application, non-refundable registration fee of $50.00 and proof of high school graduation or GEDto:Greene County Peace Officer Basic Training Academy OfficeGreene County Career Center532 Innovation DriveXenla, Ohio 45385

af GREENE COUNTY“meCRREERCENTER

FULL-TIME PROGRAM APPLICATIONAdult Education Division

Please Print All InformationToday’s Date: / /

Course Number: Course Name: Course Start Date

Name:(Last) (First) (Middle) (Maiden)

Address:(Street)

(City) (State) (Zip Code)

Telephone Number: - - E-Mail Address: @

Cell Phone Number: - - Date of Birth: /__/ Social Security Number: - -

EDUCATIONAL BACKGROUND

Type Of , Dates|Schoo! Nameof School Attended

|

City and State of Schoo} Major Attended Degree/Diploma

GED

High School

College/Other

___|EMERGENCY CONTACT INFORMATION

Name:(Last)

(First) (Middle Initial)

Address:(Street)



Cell Phone Number: - - Relationship to You:

Name:(Last)

(First)(Middle Initial)

Address:(Street)



Cell Phone Number: - - Relationship to You:

Office Use Only Registration Fee Paid on:

WorkKeys Assessment Test Date: Evidence of High School Graduation/GED:Financial Aid Office Appointment: Other:

i2f~* GREENE COUNTY=—

METHOD OF PAYMENT

FINANCIALAID: Pell Grant and Stafford Direct Loan

1. Will you complete the Free Application for Federal Student Aid (FAFSA)? LC) yes 0) no2. Do you live at home with your parent(s)?C) ves ) no3. Have you attended any other schoo! during the current school year? C) ves CQ) noIf yes, where?

4. Do you have a Bachelor, Master or Doctorate Degree?L) YES C) no

AGENCYSUPPORT:WIA, BVR, TAA, or VA

1. Have you contacted the appropriate agencyto determine your eligibility? Q) ves 1) no2. Do you have an eligibility letter from the agency?C) ves C no

EMPLOYER SPONSORED

Do you have

a

letter from your employerverifying tuition sponsorship? OQ) ves O NOPO#

SELF PAY

Amountof Tuition: Methodof Payment: *Please arrange any payment plan with the Bursar’s Office prior to the first day of class.

CERTIFICATE OF COMPLETIONis awardedto the student uponsatisfactory completion of the course, providedall fees have beenpaid.

STANDARD FINANCIAL OBLIGATION POLICY:

By signing this agreement, the student accepts financial obligation for the program of study. Financial obligation is based on tuitionand fees per academic term. A non-refundable one-time registration fee of $50.00 is charged to enroll in any Full-Time Program.SATISFACTORY ACADEMIC/ATTENDANCE PROGRESS (SAP):

The Higher Education Act of 1965 (as amended) requires each student to be making Satisfactory Academic Progress (SAP) to beeligible for federal and state financial aid programs, All students enrolled in 600 hour programsor greater, whetheror not theyreceive federal aid, are required to maintain SAP. Please refer to the Student Handbook, Section 5.

CANCELLATION AND REFUND POLICY

All monies paid by an applicant must be refundedif requested within three days after signing an enrollment agreement and makingan initial payment. An applicant requesting cancellation more than three days, but prior to entering the school,is entitled to arefund of all monies paid minus an administrative fee of $50. If such cancellation is made, the schoolshall promptly refund in full alltuition and fees paid as stated in the Enrollment Agreementand the refund shall be made nolater than 30 calendar days aftercancellation. This provision shall not apply if the student has already started the program or class.

Students may be entitled to a full refund of monies paidif:¢ Student’s application is not accepted,e¢ ~The class is cancelled.

A refund applies only to tuition. There is no refund on application fees, books, tools, uniforms, or other objects or supplies whichbecomethe property of the student.The amountof Title IV and otheraid will be applied to the student’s accountfirst, based on the hours attended prior to student’swithdraw date to covertuition. The remaining balance will become the responsibility of the student using the calculation listed inthe table below,

af GREENE COUNTY“=e CAREER CENTER

Days Enrolled Per Term Total Tuition School Shall Refund0-2 Days 100% Refund3-10 days 50% Refund

Over 10 days 0% Refund ! have read, understand and agree to abide by the Full-Time Program SAP and Refund/WithdrawalPolicy. | hereby acceptfinancialresponsibility for tuition, textbooks, supplies, tools, and lab fees that are not covered by financial aid, an agency, or employer.

Student Signature: Date:

3: AUTHORIZATION-TO,RELEASE:INFORMATIO

FERPA RELEASE:

The Family Educational Rights and Privacy Act (FERPA) of 1974is a federal law designed to protect the privacy aspects of astudent’s educational record that are not considered “directory information.” Educational.records include financial aid recordswhich are considered confidential and will not be released without written consent. For this reason,it is necessary for the GreeneCounty Career Center Adult Workforce Education Division to obtain permission from a studentin orderto releasefinancialinformation not excluded by FERPA laws,

Student Financial Aid cannotrelease anyfinancial aid information to anyone, including the student’s parents, spouses,partnering agencies (WIA, BVR, VA, TAA), or employers without consentfrom the student.

In accordance with the Federal Education Right and Privacy Act (FERPA) and Student Financial Aid Policy, t authorize the release ofmyfinancial information to partnering/sponsoring agencies (including, but notlimited to; WIA, BVR, TAA, VA) and my employerofrecord effective as of this date and until revoked or changedin writing to the Student Financial Aid Office. The release onlypertains to any financial aid records.

Signature of Student: Date:

In addition, | agree to waive anyrights under. FERPA andallow the below named person(s) access to myfinancial recordseffective as of this date and until revoked or changedin writing to the Student Financial Aid Office.

NameofIndividual: Relationship:

NameofIndividual: Relationship:

Signature of Student: Date:_-

AUTHORIZATION TO APPLY FINANCIAL AID TO STUDENT ACCOUNT| authorize the Greene County Career Center Adult Education Division to use myfinancial aid to payall outstanding charges on

mystudent account. Financialaid can include loans, grants, scholarships, agency funds, employer sponsorshipor otherinstitutional, federal, or state funds.

| agree thatif this aid is not directly credited to my account,| will endorse anyfinancial aid check(s) to the Greene CountyCareer Center Adult Education Division. | will not receive any fundsuntil all charges posted to my student accountare paid in full.| understand that completion of this form does not guarantee that my student accountwill be paid in full. Any balance remainingafter disbursement of my financial aid is my responsibility.

| authorize the Greene County Career Center Adult EducationDivision to use financialaid funds to pay any non-standardcharges assessed to my student account. These charges mayinclude, but are notlimited to, the following:book charges, lab/supplies fees, late fees, and/orinstallment plan fees, | also authorize the Greene. County Career Center AdultEducation Division to transfer any financial aid funds to any past due balances on my student account.

| understand thatthis authorization will remain active on my accountandis valid for as long as | am a Greene County CareerCenter Adult Education student. | understandthatin orderto inactivate this authorization | must do soin writing to the Bursar’sOffice at 2960 West Enon Road, Xenia, Ohio 45385. Signature of Student: Date:

Greene County Criminal Justice AcademyUniform/Ammunition Order Form

Please complete this order form and return it with your application to insure proper sizing.You are required to be in uniform for thefirst day ofclass.

Uniform polos, workout clothing, and hat are included in the tuition price.If you would like to order additional items, please indicate below.

All additional items must be paid for in advance.

Small_| Medium

|

Large

|

X-Large

|

XX-Large | S/M

|

L/XL

| Polo

Hat

T-Shirt

Sweatshirt 9mm 40 cal Sweatpants Caliber of

Shorts weapon |

Name:

Address:

Telephone:

Submit the completed notarized application and copy of valid driver’slicense to:

Greene County Criminal Justice Training Academyc/o Greene County Career CenterAdult Education Building —532 Innovation DriveXenia, Ohio 45385

Applicants will receivea letter indicating the location, date and time theywill need to be available for the Physical Assessment entry examinationand oral interview,

Revised 08/17/206

Greene County CriminalJustice Training Academy532 Innovation DriveXenia, OH 45385

Adult Education DepartmentGreene County Career Center(937) 372-6941 ext. 1551

AUTHORIZATION TO RELEASE INFORMATION

TO WHOM IT MAY CONCERN:

I hereby authorize any commissioned agent or representative of the Greene County Criminal JusticeTraining Academy, bearing this release, or a copy thereof, within one (1) year ofits date, to obtain anyinformation in yourfiles pertaining to my employment, credit, support obligation records, or educationalrecords including, but not limited to, academic achievement, attendance, personal history, disciplinaryrecords, medical (per HIPPA requirements), fitness reports and military records. I hereby direct youtorelease such information upon requestto the bearer,

This request is executed with full knowledge and understanding that the informationis for the official useof the Greene County Criminal Justice Training Academy. Consent is granted for the Greene CountyCriminal Justice Training Academyto furnish such information, as is described above, to third parties inthe course offulfilling its official responsibilities.

I hereby release you, as the custodian of such records, and any government agency, school, college,university, other educational institution, repository of military records, credit bureau, lending institution,consumer reporting agency, police departments or retail business establishment, including its officers,employees or related personnel, both individually and collectively, from any liability for damages ofwhatever kind, which mayat anytimeresult to me, my heirs, family or associates because of compliancewith this authorization and requestto release information, or any attempt to comply with it. Should therebe any questionasto the validity ofthis release, you may contact meas indicated below,

FULL NAME (Signature)

DATE

CURRENT ADDRESS

TELEPHONE NUMBER

Notary Public In and For

County, Ohio My commission expires

Notary Public Date

MEDIA RELEASE

Revised 08/17/20 . 4



MEDIA RELEASE

Date:Subject:

I do herebygrant and give to Greene County Career Center, its successor and assigns (hereinafter referredto as the school), the right to use, and to permit others to use my name, photograph, testimonial, voiceimage,or likeness onprinted material, printed film, film recording, video tape, or other sound and/orvisual device, both single and in conjunction with other personsor objects, for any andall purposesincluding butnot limited to, private or public presentations on the radio, television, in theaters,newspapers, outdoor, direct mail, promotional literature, point-of-purchase material, signs, publicity, andpromotionrelated thereto,

I warrantthat I havethe right to authorize the foregoing uses andto hereby agree to withhold the Schoolharmless of any andall liability of whatever nature which may arise outof or result from suchuses.

Signature

Printed Name

Street Address

City, State, Zip

Revised 08/17/208

Greene County Criminal

Justice Training Academy532 Innovation Drive

Xenia, OH 45385


DOMESTIC VIOLENCE INFORMATION FORMTitle 18, United States Code, Section 922 (g) (9) makesit illegal for anyone who has been convicted of amisdemeanorcrime of Domestic Violence to possess any firearm or ammunition “Misdemeanor Crime ofDomestic Violence” is generally defined as any offense, whetheror not explicitly described ina statute asa crime ofDomestic Violence, whichhas, as its factual basis, the use orattempted use of physical force, orthe threatened use of a deadly weapon, committed by the victim’s current or former domestic partner, parentor guardian. The term “convicted”is generally defined in the statute as excluding anyone whose convictionhas been expungedor set aside, or has received a pardon. Any person whohaspled guilty or no contest toa lesser charge whentheoriginal charge was domestic violence, ORC 2919.25,is noteligible to apply.

If youare affected by this statute, you may not possess any firearm or ammunition; therefore, youare noteligible for positions in the uniform forces of the any Police Department. Please answer the following:

1.) Have youever beenconvicted of a misdemeanor crime of Domestic Violencewithin the meaning of the statute? YES NO

2.) If you answered yes to Question 1, provide the following information withRespect to the conviction:

Court/Jurisdiction:

Docket/Case Number:

Statute/Charge:

Therebycertify that, to the best ofmy knowledge andbelief, all of the information provided by meistrue,correct, complete, and madein goodfaith. I understandthat false or fraudulent information provided hereinmay be grounds fordisqualification for the position of Police Recruit with the Greene County CriminalJustice Training Academy.

Applicant NamePrint or type

Signature Date

Witness Date

Revised 08/17/20 : 9



TO: Child Support Enforcement Agency

Social Security #

The above named individual is an applicant for the position of police recruit with the Greene CountyCriminal Justice Training Academy.

Would youplease verify that this individual is current in his/her alimony and/or child support obligations.If not current, would you please furnish the delinquent amount? A notarized release of information isenclosed.

Theapplicant provided the following information concerning his/her obligations.

Obligee:

Children:

N/A:Print name

Thank youfor your assistance.

Sincerely,

MichaelHildSr.

Michael Hild Sr.

Academy Commander

Revised 08/17/20 10



TO: National Personnel Records Center(Military Personnel Records)9700 Page Blvd.St. Louis Missouri, 63132

FROM: Name:

Date of Birth:

Social Security #:Branch ofService:

Dates of Service:

The above namedindividualis an applicantfor the position ofPolice Recruit with the Greene CountyCriminal Justice Training Academy, Xenia, Ohio.

Would youplease verify the above information and forwardhis/her complete military history records(excluding medical), The necessary authorization for the release of this information is enclosed.Thankyou in advancefor your assistance,

N/A print name

Sincerely,

Michack Hitd Sx.

Michael Hild Sr.Academy Commander

Revised 08/17/2011

Type or print all information

GREENE COUNTY PEACE OFFICER BASIC TRAININGPERSONAL INVESTIGATION WORKSHEET

HOW DID YOU LEARN OF THE CRIMINAL JUSTICE TRAINING ACADEMY?:INSTRUCTIONS: This applicationis to befilled out in complete detail. Failure toprovide information or givefalse information could result in yourrejection. Ifyou need to make any corrections, please initial nextto each,

YOUR FULL NAME(LAST) (FIRST) (MIDDLE)

ANY OTHER NAMES YOU HAVE USEDoo

MAIDEN NAME; NICKNAME;ee moPRESENT ADDRESS:

(STREET AND APT, #)

(CITY) (STATE) (ZIP CODE)

LIST ADDITIONAL ADDRESSES WHERE YOU MAYBE CONTACTED:

a

TELEPHONE NUMBERS: (HOME) (WORK)

SOCIAL SECURITY#: BIRTHDATE:aa

BIRTHPLACE:Tr

ARE YOUA U.S, CITIZEN: YES NO HEIGHT WEIGHT

HAIR COLOR EYE COLOR

SCARS/MARKS/TATTOOES __. SPECIFY LOCATION

MARITAL STATUS:(MARRIED,SINGLE, SEPERATED, DIVORCED)

SPOUSE’S FULL NAME:TT

SPOUSE’S SOCIAL SECURITY#: BIRTHDATE:

SPOUSE’S ADDRESS(IF DIFFERENT):(STREET AND APT.#)

(CITY) (STATE) (ZIP CODE)SPOUSE’S EMPLOYER:

(NAME OF COMPANY)

EMERGENCY CONTACT, NAME AND PHONE NUMBER #1.

EMERGENCY CONTACT, NAME AND PHONE NUMBER #2eee

CHILDREN’S NAME(S) AND AGES(S):

> OQ tt |NAME

IF PREVIOUSLY MARRIED, LIST FORMER SPOUSE’S NAME & ADDRESS

NAME:

(LAST) (FIRST) (MIDDLE)

ADDRESS:

(STREET AND APT. #)


WHEN / WHERE DIVORCED?

WHAT METHOD OF PAYMENT WILL YOU BE USING FOR YOUR TUITION? CASHTHREE PAYMENT PLAN VISA/MASTERCARD FINANCIAL AID:

CHECK IF YOU KNOW WHAT PLAN YOU WILL BE USING OR IF YOU HAVE PREVIOUSLY USEDANY OF THE FOLLOWING:VA PELL BYR TRA/TAA WIA

GREENEWORKS WORKPLUS

WHAT DO YOU SEE YOURSELF DOING ONE YEAR FROM NOW?eee

WHAT DO YOU SEE YOURSELF DOING FIVE YEARS FROM NOW?eee

Revised 02/21/17

19

PREVIOUS RESIDENCES

LIST IN CHRONOLOGICAL ORDER ALL PREVIOUS ADDRESSES WITHIN THE PAST 5 YEARS,

DATES (FROM MONTH/YEAR TO MONTH/YEAR)ee

ADDRESS: (STREET AND APT.#)

(CITY) (STATE) (ZIP CODE)OWNED OR RENTED?Tee

MORTGAGE HOLDER OR LANDLORD ?

DATES (FROM MONTH/YEAR TO MONTH/YEAR)

ADDRESS: (STREET ANDAPT. #)

(CITY) (STATE) (ZIP CODE)OWNED OR RENTED

MORTGAGE HOLDER OR LANDLORD 9


ADDRESS: (STREET AND APT.#)

(CITY) (STATE) (ZIP CODE)OWNED OR RENTED?



ADDRESS: (STREET AND APT.

(CITY) (STATE) (ZIP CODE)OWNED OR RENTED?


RELATIVES

PARENTS’ NAMES AND ADDRESSES:

MOTHER’S NAME:

(LAST) (FIRST) (MIDDLE)ADDRESS:

(CITY) (STATE) (ZIP CODE)FATHER’S NAME:

(LAST) (FIRST) (MIDDLE)ADDRESS:

(CITY) (STATE) (ZIP CODE)TELPPHONE NUMBERS:

(MOTHER) (FATHER)

DO YOU HAVE ANY RELATIVES CURRENTLY WORKINGIN OR RETIRED FROMLAW ENFORCEMENT? _. IF SO, PLEASE LIST THEIR NAME AND DEPARTMENT/AGENCY:

Revised 02/21/17

PLEASE LIST SIX REFERENCES INCLUDING NAME, ADDRESS AND TELEPHONE NUMBER:

THREE PERSONAL REFERENCES (NOT RELATIVES)

THREE PROFESSIONAL REFERENCES

PHYSICAL AND PSYCHOLOGICAL

DO YOU HAVE ANY PHYSICAL OR PSYCHOLOGICAL LIMITATIONS OR INJURIES (RECENT OR OLD)THAT MIGHT RESTRICT YOUR FULL PARTICIPATION IN THE ACADEMY? Yes No

ARE YOU DISABLED IN ANYWAY?

HAVE YOU EVER RECEIVED MENTAL HEALTH TREATMENT? Yes NoIF YES, PLEASE EXPLAIN:

DO YOU SUFFER FROM POST TRAUMATCI STRESS DISORDER (PTSD)?

Revised 02/21/1716

EDUCATION

IF YOU PROGRESS TO THE NEXT STEP OF THE HIRING PROCESS, COPIES OF YOUR HIGH SCHOOLTRANSCRIPTS OR GED CERTIFICATE AND COLLEGE TRANSCRIPTS WILL BE REQUIRED.LAST HIGH SCHOOL ATTENDED:eeeADDRESS:

(STREET) (CITY) (ZIP CODE)DATE OF GRADUATION (MONTH/YEAR):oo

IF YOU DID NOT GRADUATE AND OBTAINED A GED PLEASE FURNISH THE FOLLOWINGINFORMATION:

DATE RECEIVED: STATE RECEIVED:eee

COLLEGES ATTENDED:

NAME:CO

ADDRESS:

(CITY) (STATE)DATES ENROLLED:OT

GRADE POINT AVERAGE: CREDIT HOURS EARNED:

MAJOR:DEGREE:a

DATE OF GRADUATION (MONTH/YEAR);:ee

NAME:Te

ADDRESS:

(CITY) (STATE)

DATES ENROLLED:a

GRADE POINT AVERAGE: CREDIT HOURS EARNED:

MAJOR:DEGREE:mee

DATE OF GRADUATION (MONTH/YEAR);:oe

LIST ANY ADDITIONAL POST HIGH SCHOOL TRAINING:ee

Revised 02/21/17

17

EMPLOYMENT

LIST CHRONOLOGICALLY ALL EMPLOYMENTFOR THE PAST 5 YEARS INCLUDING PART-TIME ANDTEMPORARY EMPLOYMENT. ALL TIME MUST BE ACCOUNTEDFOR.IF UNEMPLOYED, LIST DATES.ALL ADDRESSES MUST BE COMPLETE, INCLUDING ZIP CODES, PLEASE LIST PRESENT EMPLOYERFIRST,

EMPLOYER:

ADDRESS: (4 (STREET) (CITY) (STATE) (ZIP CODE)

DATES OF EMPLOYMENT:

TYPE OF WORK: SUPERVISOR:

REASONFOR LEAVING:

EMPLOYER:

ADDRESS:(#) (STREET) (CITY) (STATE) (ZIP CODE)



REASON FOR LEAVING:

EMPLOYER:

ADDRESS:(#) (STREET) (CITY) (STATE) (ZIP CODE)



REASON FOR LEAVING:

Revised 02/21/171Q

EMPLOYER:

ADDRESS: (4 (STREET)



TYPE OF WORK:

REASON FOR LEAVING:

SUPERVISOR:

EMPLOYER:

ADDRESS: (4) (STREET)


(CITY) (STATE) (ZIP CODE).

TYPE OF WORK:

REASONFOR LEAVING:

SUPERVISOR:

HAVE YOU APPLIED FOR EMPLOYMENTWITH A POLICE DEPARTMENT?IF YES, LIST NAME OF DEPARTMENT AND DATE OF APPLICATION:

DEPARTMENT DATE OF APPLICATION

HAVE YOU EVER BEEN DENIED EMPLOYEMENT ANYWHERE ?

FROM WHERE ?

PLEASE EXPLAIN:

Revised 02/21/17

19

MILITARY (ACTIVE DUTY ONLY)

BRANCH: DATES OF ACTIVE SERVICE:

LAST DUTY STATION: (NAME) (CITY) (STATE)

SERIAL #: HIGHEST RANK ATTAINED:

DISCIPLINARY ACTION / TYPE:

IF YOU ARE A FORMER OR CURRENT MEMBER OF THE RESERVES OR NATIONAL GUARD PLEASEANSWER THE FOLLOWING:

BRANCH: HIGHEST RANK ATTAINED:

PRESENT DUTYSTATION:

DATES OF SERVICE:

ARE YOU REGISTERED WITH SELECTIVE SERVICE ?

IF YOU ARE A MILITARY VETERAN AND PROGRESS TO THE NEXT STEP IN THE HIRING PROCESS, ACOPY OF YOUR DD214 WILL BE REQUIRED, ALSO, PERSONS REQUIRED TO BE REGISTERED WITHSELECTIVE SERVICE WILL BE REQUIRED TO FURNISH PROOF OF REGISTRATION,

Revised 02/21/17Nn

FINANCIAL HISTORY STATEMENTS

HAVE YOU EVER HAD YOUR WAGES ATTACHED OR GARNISHED?

HAVE YOU EVER BEEN A DEFENDANT IN SMALL CLAIMS OR OTHERCIVIL ACTION? DO YOU HAVEANYCIVIL ACTION PENDING AGAINST YOU?

HAVE YOU EVER HAD A JUDGEMENT RENDERED AGAINST YOU?

HAVE YOU EVER BEEN REFUSED AN INSURANCEPOLICY?

HAVE YOU EVER HAD AN INSURANCEPOLICY CANCELLED?

HAVE YOU EVER BEEN REFUSED CREDIT?

HAVE YOU EVER HAD ANY PROPERTY REPOSSESSED?

DO YOU CURRENTLY HAVE ANY ACCOUNTS UP FOR COLLECTION?

10. IF YOU ARE OBLIGATED TO PAY CHILD SUPPORT AND/OR ALIMONY,ARE YOU CURRENT IN YOUR PAYMENT? IF YOUANSWEREDYESTOANY OF THE PREVIOUBELOW:

Revised 02/21/17

S QUESTIONS(1-10) ORNO TO #10 PLEASE EXPLAIN

1

TRAFFIC RECORD

INCLUDE A LEGIBLE COPY OF YOUR DRIVER’S LICENSE

DRIVERS LICENSE# STATE ISSUED

LIST ALL TRAFFIC VIOLATIONS (EXCEPT PARKING TICKETS) FOR WHICH YOU HAVE BEENCONVICTEDIN THE PAST 10 YEARS:

DATE POLICE AGENCY. CHARGE COURT OFDISPOSITION

HAS YOUR LICENSE EVER BEEN REVOKED OR SUSPENDED?IF YES, PLEASE EXPLAIN:

DO YOU OWN AN AUTOMOBILE, OR HAVE ONE AT YOUR DISPOSAL?IF YES, PLEASE ANSWER THE FOLLOWNG QUESTIONS:YEAR MAKE MODEL

INSURANCE COMPANY/AGENTTYPE OF COVERAGE HIGH RISK?

eee

CRIMINAL RECORD

HAVE YOU EVER BEEN ARRESTED? DATE OF ARRESTREASON FOR ARREST?

LIST ALL CRIMINAL VIOLATIONS FOR WHICH YOU HAVE BEEN CONVICTED OR ADJUDICATED:

DATE POLICE AGENCY CHARGE COURT OFDISPOSITION

Revised 02/21/17ay

DRUG HISTORY

EXAMINE THE FOLLOWING LIST OF DRUGUSAGE, IF ANY, IN EACH PARTICULAR CATEACH QUESTION:

Drug Type Yes No HALLUCINOGENICDRUGS

MARIJUANA

HASHISH/HASH OIL THC

LSD

PCP

DMT

PEYOTE

MESCALINE

STIMULANTS

COCAINE (ALL FORMS) AMPHET AMINES

DEPRESSANTS

BARBITURATES

TRANQUILIZERS

OTHER NARCOTICSUBSTANCES

OPIUM

MORPHINE

HERION

CODEINE

METHODONE

DILUDID

DEMEROL

HARMFUL INTOXICANTS ORGANIC SOLVENTS

(THINNER, CLEANINGFLUID,GASOLINE, PLASTIC CEMENT,ETC.) ANY AEROSOL PROPELLANT ANY FLUOROCARBON

REFRIDGERANT ANY ANESTHETIC GAS

OTHER SUBSTANCES NOT PREVIOUSLY SPECIFIED

[TYPE(S]

Revised 02/21/17

S AND SUBSTANCES TO DETERMINE YOUR ILLEGALEGORY, PLEASE CHECK APPROPRIATE RESPONSE TO

99

PLEASE ANSWER THE FOLLOWING QUESTIONS CONCERNING YOUR ILLEGAL DRUGACTIVITIES, IFee eiYOU HAVE NEVER USED DRUGS ILLEGALLY, GO DIRECTLY TO QUESTION #11. (IF A QUESTIONDOES NOT APPLY, INSERT DNA):

L.

2.

. HAVE YOU EVER CULTIVATED MARIJUANA?

AT WHATAGEDID YOUFIRST USE DRUGS/TYPE(S)?

DATE (MONTH/YEAR) YOU LAST USED DRUGS/TYPE(S)?

. WHAT IS THE LARGEST AMOUNTOF DRUGS YOU HAVE EVER PURCHASED/

TYPE(S)?

- WHAT IS THE LARGEST AMOUNTOF DRUGS YOU HAVE EVER SOLD/

TYPE(S)?

. WHAT IS THE LARGEST AMOUNT OF DRUGS YOU HAVE EVER TRANSPORTED/

TYPE(S)? WHEN?

AMOUNT? WHEN?

. HAVE YOU EVER ILLEGALLY OBTAINED ANY PRESCRIPTION DRUG AND IF SO,

LIST TYPE AND HOW OBTAINED?

- HOW MANY CLOSE FRIENDS DO YOU KNOW WHO USE DRUGS AND WHAT

TYPES OF DRUGS DO THEY USE?

. HOW MANY TIMES HAVE YOU GIVEN OTHERS MONEY TO BUY DRUGS?

WHATTYPE(S)?

Revised 02/21/1724

10, EXTENT OF ILLEGAL DRUG USAGE (List specific drug at the bottom ofthis page):

More 20 to 10 to 20 2to ld One

than 50 50 times times timeDrug Category times times

HALLUCINOGENICDRUGS

STIMULANTS

DEPRESSANTS

OTHER NARCOTICSUBSTANCES

HARMFUL INTOXICANTS

11. DO YOU CONSUME ALCOHOLIC BEVERAGES?

12, IF YOU ANSWEREDYESTO #11, WHAT IS YOUR CONSUMPTION?:

PER WEEK TYPE(S)?

13. HAVE YOU EVER SUCCESSFULLY COMPLETED A SUPERVISED DRUG AND/OR

ALCOHOL REHABILITATION PROGRAM? (IF YES, YOU WILL BE REQUIRED TO

FURNISH PROOF OF SUCCESSFUL COMPLETION UPONREQUEST)

14, IF YOU ANSWEREDYESTO #13, HAVE YOU REMAINED ALCOHOL AND/OR DRUG

FREE SINCE THE COMPLETION DATE OF YOUR PROGRAM:

IF NO, PLEASE EXPLAIN:

IF NECESSARY, USE THE FOLLOWING SPACE TO EXPLAIN OR ADD TO YOUR ANSWERS, MAKEREFERENCE TO THE PARTICULAR PAGE NUMBER, SECTION, AND QUESTION:

Revised 02/21/1725

CERTIFICATION

I CERTIFY THAT THE STATEMENTS HEREIN CONTAINED ARE TRUE TO THE BEST OF MYKNOWLEDGE AND UNDERSTAND THAT ANY FALSE STATEMENTS OR OMISSIONS OF INFORMATIONMADE IN THIS APPLICATION MAY BE CAUSE FOR DISAPPROVAL OF MY APPOINTMENT OR FORDISCHARGE AFTER APPOINTMENT,

(SIGNATURE) (DATE)

, appeared before me on the day of year

(NOTARY)

Notary Public in and for County, Ohio. My commission expires

Revised 02/21/17Ac

CAREER CENTER

Health Data Form(physical):C1 Physical to be completed no more than 180 daysspriorto first day of academytraining1 Schedule physical at doctor’s office, urgent care, walk-in clinicO) Present Health Data Form to PhysicianO Return completed Health Data Form to academyoffice

Requestfor National WebCheck Form (fingerprinting):Q Fingerprinting to be completed no more than 150 days priorto first day of academy

trainingO Visit the Greene Co. Sheriff’s Office between 8-3 M-F —walk-in onlyO1 No charge forfingerprintingUO Present Requestfor National WebCheckQ Return completed Requestfor National WebCheck to academyoffice

5 Panel Drug Screen:C1 5 Panel Drug Screen to be completed no more than 150 days prior to first day of

academytrainingCI Visit Hometown Urgent Care in Xenia (101 S. Orange St) for walk-in testingUi Present 5 Panel Drug Screen Consent form0 Cost of the 5 Panel Drug Screenis $45LO] Hometown Urgent Care will fax results to academyoffice

Note: Hometown Urgent Care offers physicals for $55, If you would like to complete your physicalat thesame time as yourdrugtesting, please call 937-372-6012 to schedule an appointment to avoid waiting inthe “Urgent Care”line.

Hometown

igh URGENT ¢Employer Service Authorization se

“oS & OCCUPATIONAL HEALTH eScreen Acct 25605-1101

Form

Please present your photoidentification at time of check-in.

Last Name oe First Name MISSN

DOB Gender OM OCFStreet

City State ZipHome Phone Mobile PhonePreferred Language Race O) American Indianor Alaska Native; 0 Asian; © Black or African Ethnicity 0 Hispanic or Latino

ican; i eHa alian or Pacific Islander; O White ©) NotHispanic

or

Lati

| Employer: GREENE CCC- CRIMINAL JUSTICE ACADEMY Contact Name:Tracey R. CasselStreet: 532 Innovation Drive

City: XENIA | State OH | Zip: 45385Employer Phone: 937-372-6941 x 1551 Employer Fax: Contact Signature:BEACSOAICCOR

Cl Pre-Employment ORandom (1 Post-Accident O Follow-Up [Reasonable Cause 1 Initial InjuryIs this visit for a DOT (Department of Transportation) Screening/Test OYes [No

PHYSICAL: [J PRE-EMPLOYMENT (USE GREENE CCC STUDNET HEALTH DATA PHYSICAL FORM ONFILE)URINE DRUG SCREENING: CJ RAPID 5 PANEL (ECUP)

BREATH ALCOHOLTESTING: CJ STANDARD NON-DOT

OTHER:

By signing this consent form | acknowledge that| have read, understand, voluntarily consent to and authorize the following:

Authorization of Treatment:

| authorize the administration of all medical tests and procedures that will be performed during today’svisit.

Receipt of Privacy Practices:

| acknowledge that a copy of the Notice of Privacy Practices of Hometown Urgent Care has been offered/is available to me upon request.

Patient Signature Date

Release of Medical Records:

| authorize HometownUrgent Care to release verbally, electronically and/orin writing confidential medical information obtained during the courseof my examination and/ortreatmentto any personorentity including my insurancecarrier, employer (if treatment is related to employment),and/or other healthcare provider(s) for purposes of treatment, payment of charges, quality assurance and utilization review. | understand thatshould | choose notto release my medicalrecords to a specific entity and/or person(s) | must specifically state so in writing for inclusion in mymedical record.

Patient SignatureDate

ES-100-01 Revised 1/3/2017

SEINE COUNTYCAREER CENTER

Greene County Criminal Justice Academy

UNIFORM

The following items ARE provided with tuition:

(2) GCCC Polo Shirts(1) Baseball style Cap

The following items are the STUDENT'SRESPONSIBILITY:

(2) Pairs of trousers (A.E. David' s/David's Uniforms)Duty Belt (Inner/outer black belt. Prefer leather, will accept quality nylon)Keepers

Holster

Mag carrier (Prefer leather, will accept quality nylon)Cuff case (Prefer leather, will accept quality nylon)Hinged or chain link cuffs

Large cuff key

FlashlightringFlashlight (Mag-lite style)

21" Collapsible batonBaton holderBlack boots/shoesthat can be polishedBlack socks to be worn with academy uniform

***Please reference “A.E. David Company"pricelistfor "GCCC PRICE". David's willhonor the discountedprice ifyou presentthe order blank in store. The only items you arerequired to purchasefrom A.E. David's are the trousers. You maypurchase duty belt andequipmentat retailer ofyour choice. ***

PHYSICAL FITNESS

The following items ARE provided withtuition:(1) GCCC T-Shirt(1) GCCC Shorts(1) GCCC Sweatpants

(1) GCCC Sweatshirt

Thefollowing items are the STUDENT'SRESPONSIBILITY:

Duty BagBackpack and/or gym bagRunning shoesWhite socks

FIREARMS

The following items ARE provided with tuition:All range ammunition

The following items are the STUDENT'SRESPONSIBILITY:40 caliber or 9mm handgun (no 45's unless currently carried for employment)At least 3 magazinesEye protectionEar protection

Firearm cleaning kit

Lint-free rags

Toothpicks

Students are required to provide a firearm to be used only during the firearmsportionof thecurriculum (2 weekperiod). You will be provided with a letter on the first day oftraining thatwill entitle you to purchase a weaponat reduced pricing.

CLASSROOM

The following items ARE provided with tuition:OPOTCcurriculum andall textbooks

The following items are the STUDENT'SRESPONSIBILITY:

(4) White three-ring binders with clear presentation cover (3 inch)Tabs for bindersPens (black)Access to computer for word processing (notes must be typed)Reliable transportation

You MUSTbein uniform bythefirst dayof instruction.

A. E. DAVID COMPANY 3/27/2020

ATE LAW ENFORCEMENT UNIFORMS

' 342 TROY STREET - PO BOX 132FOOTWEARIS NOTAPPROVEDDAYTON, OHO 8404-013 GREENE COUNTY: PHONE (937) 228-77537 | eer! CAREER CENTERDRESSTY ZIP LAW ENFORCEMENT GEARJONE EMAIL MR. HILD

GcccITEM# ITEM DESCRIPTION SIZE QTY PRICEF5251 KHAKI TACTICAL TROUSERS$29.95

MEA7ae528104 INNER VELCRO SYSTEM BELT, FOR TROUSERS $14.95528100 OUTER DUTY BELT, VELCRO SYSTEM, 2" WIDTH $27.95520948 KEEPERS, VELCRO (PAIR)

$5.95528101 MAGAZINE HOLDER, DOUBLE$19.95520819 HANDCUFF CASE, CLOSED, HINGED OR LINKED CUFFS $14.95

520606 RECHARGEABLE MINI LIGHT HOLDER $7.95520816 EXPANDABLE BATON HOLDER

$13.95 eaGe

520000 INNER VELCRO SYSTEM BELT, FOR TROUSERS $27.95520601 OUTER DUTY BELT, VELCRO SYSTEM,2 1/4" WIDTH $56.95520800 KEEPER, LEATHER

$3.50525601 MAGAZINE HOLDER, DOUBLE

$29.95920860 HANDCUFF CASE, CLOSED, HINGED OR LINKED CUFFS $26.90526863 RECHARGEABLE MINI LIGHT HOLDER $19.95521151 EXPANDABLE BATON HOLDER $24.95

560067 PEERLESS HINGED HANDCUFFS$41.95

560078 PEERLESS LINKED HANDCUFFS$29.95

560901 ASP LINKED HANDCUFFS$56.95

560713 ASP HINGED HANDCUFFS$69.95

520190 LARGE HANDCUFF KEY, POCKET STYLE $9.95_ BQTene

520267 ASP BATON, BLACK ANODIZED,21" Jp $119.95R10078 21".BATON WITH FREE NYLON HOLDER K@:SPECIAL! $29.95

BLACKHAWKSERPA® CQC® MATTEFINISH $49.99

$19.95

560635 feyRyEa eefee] RANGE HEARING PROTECTOR MUFFSECT

561301 600 LUMEN RECHARGEABLE FLASHLIGHT $39.95

Peace Officer Basic Training

Student Handbook

Ohio Peace Officer Training Commission1650 State Route 56, SW ® P.O. Box 309 « London, Ohio 43140

Phone: 800-346-7682

Effective 1/1/2021

Things to Know

The Ohio Peace Officer Training Commission

The Ohio Peace Officer Training Commission (OPOTC) consists of ten members appointed by the

governorwith the advice and consent of the Ohio Senate. Members serve three-year terms. The

Commission issues recommendationsto the Attorney General about matters pertaining to law

enforcementtraining, approves OPOTC curriculum, certifies individuals for numerous Ohio law

enforcement professions, and establishes annual continuing professional training (CPT)

requirements for peace officers and troopers.

The day-to-day work of the OPOTCis done by the Executive Director and staff members.The staff

members you may encounter include compliance officers and certification officers.

Complianceofficers are the Commission’s eyes and ears at each training academy. They

communicate regularly with commanders and instructors to ensure that academies comply with the

standards required by the Ohio Revised Code, the Ohio Administrative Code, and the OPOTC.

Certification officers verify that instructors and commanders have the prerequisites, training, and

-—_—~——experienceneededto instructin-orcommand_an.academy __

The Ohio Peace Officer Training Academy

The Ohio Peace Officer Training Academy (OPOTA) and the OPOTCare twodifferent entities but are

often confused. The Commission established the Academy which includes two campuses in London

and onein Richfield. The Academyprovides advancedtraining courses to those whoare already

certified officers. They offer operator-level and instructor-level courses. OPOTA generally does not

teach or develop basic training.

Your Academy

Your academyis administered by your commander. You can think of a commanderassimilar to a

principal of a school. The commanderchoosesinstructors, schedules course topics and locations,

and ensuresthat the instructors have the tools needed to teach their topics. Commanders and

instructors must all be approved andcertified by the OPOTC.

Academy Requirements

The minimum hours required by the Commission must be taught by your academy, but additional

required hours can be added by your academy.

To enter your academy, you must successfully complete a drug screen, pass a criminal background

check, and meet certain minimum standards based on a physicalfitness assessmentthat includes

sit-ups, pushups, and a 1.5-mile run.

Effective 1/1/20212

To beeligible for OPOTC certification as a peace officer, you will need to successfully completecertain skill-based student performance objectives (SPO’s), meet higher physical fitnessassessment standards, and passa written state certification exam (SCE) showing knowledge ofcognitive-based SPO's.

Missing Class Topics or Portions of Class Topics

There may come a time when you miss a class topic or a portion of a topic.As all hours aremandatory, sign-in and sign-out sheets are very important, and the times must be documented tothe minute. If you are tardy to class, the time must be made up.If that time missed is 15 minutes orless, that specific time can be made up at the end ofthe class day with theoriginal instructor,ifthat instructor is available and willing to do so.

If you are more than 15 minutes late, you will have to make up class time at a later time, in 30-minute increments. As your academyhashired instructors to teach during the core hours of thecourse, it is not unusual for an academytobill you for the additional instructor time required toconduct a make-upsession.

There may be times when,duetoillness, injury, or personal conflicts, one or more days of classwillbe missed. Due to the waythe curriculum is developed and the orderin whichit’s presented, thosetopic hours missed must be made up within 14 days of the date you return to class.If they are not,then starting on that 15th day, you are not permitted to attend any other academytopics until themissed topics are completed.

If you are going to be absent for an extended amount of time, you must contact the commanderforinformation about obtaining an extension. Extensionsare available for military and medicalpurposes.All extension make-ups and assessments must occur within one year of the date theacademy began.

Appointed Students and Open Enrollment Students

Somestudents are appointed by a peaceofficer agencyprior to completing their academy andbecomingcertified. These students possess peaceofficer powers,in their jurisdictions, as soon asthey pass the SCE and are issued an Ohio peaceofficer training certificate.

Other students complete their academy successfully but have notyet receivedtheirfirst peaceofficer appointment. These students are known as “open enroliment students.” They do not initiallyreceive an Ohio peaceofficer training certificate. Instead, they receive a letter of completion. Oncethey are appointed by a peaceofficer agency, they are issued a training certificate (subject to anyadditional required training that has been mandatedin the interim) and they then possess peaceofficer powersin their jurisdiction. Simplified, peace officer certification requires both completion oftraining and an agency appointment.

If an open enrollment student obtains an appointment after one year of successfully passing theSCE, the student must take a refresher course and pass a refresher exam before gaining

Effective 1/1/20243

certification. If an open enrollment student does not get an appointment within two years of

successfully passing the SCE, the student must repeat peace officer basic training.

If during the academyyour appointmentstatus should change from open enrollment to appointed,

or from appointed to open enrollment, you must notify the commander immediately.

Things to Do

Required Forms

The following forms are attached and must be completed and returned to your commander

immediately. Any delay in completing and returning these forms may result in a denial of your

request to attend the academy.

e Student Handbook AcknowledgementandVerification

e SF1415unv - Student Enrollment/Certification Record

e SF102bas - Request for National WebCheck ~~

ee~SF104unv-FERPAConsenttoReleaseStudentInformation _

e SF114bas - Student Health Data

Affirmations

Below are a numberof questions and acknowledgments that you must review and answer.If

there is any statement you are not able to answer affirmatively, please explain in detail on the

Student Acknowledgment and Verification form at the endofthis handbook. If you are in doubt

as to any of these matters or have questions on how to answer, please consult with your

commander.

A. Statement of understanding.

| have never plead to or been convicted of a criminal offense or been adjudicated for

a juvenile offense in any jurisdiction. (When reviewing this acknowledgment, please

acknowledgeall matters, even those that have been sealed or expunged).

If you have plead, and so are not able to answer affirmatively, then on the last page

of this handbooklist the court that was involved, and the underlying crime to which

you plead, were convicted, or were adjudicated delinquent.

Also,if the crime involved has, as an elementof that crime, the use or attempted use

of physicalforce, or the threatened use of a deadly weapon, also list whether the

victim was a stranger, present or former spouse, household member, child, other

family member,orif other, please describe.

Effective 1/1/2021A

1. lam nota fugitive from justice, and | do not have criminal charges pendingagainst mein anyjurisdiction,

2. | am not drug dependent, in danger of drug dependence,or a chronic alcoholic.

3. | have never been adjudicated by any court for mental incompetence, beenadjudicated by a court as a mental defective, been committed by a court to amentalinstitution, been found by a court to bea mentally ill person subject tohospitalization by court order, or been an involuntary mental patient other thanone who wasonly a patient for observation.

4, lam not an alien whoisillegally or unlawfully in the United States.

5. | have never been discharged from the Armed Forces underdishonorableconditions.

6. | have never renounced my United States citizenship.

¢. lam not under a court order that restrains me from harassing, stalking, orthreatening an intimate partner or the child of such partner, or engaging in otherconduct that would place an intimate partner in reasonable fear of bodily injury tothe partnerorchild.

8. | currently possessa valid driver’s license and have driving privileges in the Stateof Ohio.

9. | have been awarded and possess a high school diplomaora certificate of highschool equivalency.

If you possessa certificate of high school equivalency, please provide a detailedexplanation on the last page of this handbook.

10. | understand thatif | provide false information on this form I may be dischargedfrom this academy and may be charged with a crime.

11. | understandthatif a criminal or delinquency chargeis filed against me while | ama studentof this academy, | must report it to the commander immediately, and|may be suspended from this schoo! until the case is complete. Depending on theresolution at that time, | may be ineligible to attend the academy.

12. | grant the OPOTC consentto disclose to the commander any informationregarding any andall of my criminal or delinquencyhistory information that mightimpact myability to participate as a student in an OPOTC-approved academy.Likewise, | grant the commanderconsentto disclose the same information to theOPOTC.

Effective 1/1/2021

13.

14.

The OPOTCis committed to maintaining an academic environmentin whichall

individuals are treated with respect and dignity, free from any typeof

discrimination or harassment, and will not tolerate discrimination or harassment

in an OPOTC program, whether committed by a student, an instructor, a

commander, or another associated with the program.| understand that | must

report incidencesof discrimination or harassment to my commander and/or an

OPOTC compliance officer, whether that behavior involves a student, an

instructor, or another associated with the program. If the behavior involves a

commander, | must report incidences of suspected discrimination or harassment

to the academyorganization’s senior managementand the OPOTC compliance

officer. If a student has engaged in discrimination or. harassment, the student

may be suspendedor expelled from the OPOTC program.

| understand that to beeligible to take the OPOTC SCE,| must have 100%

attendancein every hourofeverytopic.If | have an excused absencefor any

topic hours,it is my obligation to make arrangements with the commanderto

make up the missed topic hours within 14 days of the date | return to class,

unless excused by way of a medical or military extension. If the make-ups do not

- occur within this time frame,| cannot attend other academytopics. until all make-

ups have been completed.If | complete make-up hours in another academy,|

must attend the entire blockof instruction for that topic. | understand that the

15.

16.

17.

18.

commander mayset stricter requirementsthantheOPOTC minimumvstandards,”

To beeligible to take the OPOTC SCE, | must maintain a notebook during the

OPOTC course and that notebook must be deemedsatisfactory by the

commander. The notebook shall contain appropriate entries of pertinent material

covered during the classroom sessionsof the course. | must submit this notebook

to the commanderfor inspection at the conclusion of the program or other times

the commanderseesfit. It will be evaluated by the commanderon,at a minimum,

its sufficiency of course content, organization, and appropriateness of material,

regularity of entries, neatness, accuracy, and legibility.

To be eligible to take the OPOTC SCE,| must first demonstrate to the satisfaction

of my instructors and commanderthe requisite proficiencies in each skill-based

SPO andfinal physical fitness assessment. | then must pass the written OPOTC

SCE with a score of at least 70%. | understand | will have two attempts to pass

each skill-based SPO, physicalfitness assessment, and state certification exam.

| will not disclose any information concerning specific questions on the OPOTC

state certification examination.

if | request any special accommodations (such as thoserelating to

learning/reading disabilities, dyslexia, etc.) for the SCE, then at least 45 days

before the last day of OPOTC topics, my commander must submit written

documentation supporting my request to the OPOTC.| understand thatif this

request and documentationis not submitted by that time, | may be prevented

from receiving an accommodation.

Effective 1/1/20216

B. Medical issues, physical assessments, and waiverof liability & indemnity agreement.

1. [understand that somerisks, hazards, or dangers are inherent in the nature ofthe training and cannot be eliminated or reduced, including those that can causephysical or emotionalinjury, disability, or death. | understand and agree that lamparticipating in this training course at my ownrisk.

| understand that the training involves a degree of physical exercise and physicalcontact, which involvesa risk of injury to me.

| understand that | will have to endure some degree of discomfort or pain duringthe application, instruction, or demonstration of certain techniques and/orcertain training sessions.

2. | have received a medical examination and medical approval signed by a medicaldoctor (MD), osteopath (DO), physician’s assistant (PA), or certified nursepractitioner (CNP)licensed by the Ohio State Medical Board, the Ohio State Boardof Nursing, a neighboring state’s equivalent, or a medical professional with the USDepartment of Veterans’Affairs.

3. If | have a medical or other condition and have been medically cleared toparticipate in the training, | understand that participation may exacerbate thecondition.

4. If | develop or am diagnosed with any suchillness, injury, condition, disability, orcondition during the courseof the training program,| shall promptly notify mycommander,instructors, and school personnel and resubmit to a medicalexamination and obtain approval from a medical provider acceptable to OPOTCinorderto continueto participate in training.

5. |am in good physical and mental health, | agree to abide by the course safetyrules and instructions given by the instructors, and| agree that to receive a letterof completion or a peaceofficer training certificate for this training | must pass allapplicable tests and test components,including but not limited to sit-ups, push-ups, and a 1.5-mile run.

6. | have been informed by the commanderof the physicalfitness requirements formy age and sex, and I understand that | must meet these requirements in eachcomponentof a physical assessment, whichwill be held within the last 80 hoursof scheduled OPOTCtopics. | further understand that | will be given twoopportunities to meet those requirements. | understand thatif| fail anyrequirement during my first attempt, | must meet the requirementsforall threeevents during the second attempt. | understand that an unexcused absence froman assessment constitutes a failure of the OPOTC physicalfitness assessment.Itis my obligation to notify my commanderbefore a scheduled assessment,if|suffer anyillness, injury, or condition, which might preclude myparticipation inthe assessment. | understandthatif | sufferillness or injury during an attempt,the attempt will be counted asa failure.

Effective 1/1/2021

If | wish to request an extension of time for an assessmentfor medical reasons,|

understand that | must give the commandera written excuse, signed by a

medica! doctor (MD), osteopath (DO), physician’s assistant(PA), certified nurse

practitioner (CNP) licensed in Ohio, on a form prescribed by the OPOTC.If lam

granted an extension of time to complete the assessment | will receive a letter

from the OPOTC Executive Director notifying me of the extension, and a deadline

date for when | must complete the physical assessment, | must complete the

make-up assessmentandre-test(if necessary) before my extension expires, and

it must be completed at the enrolled academytrainingfacility.

C. | understand that OPOTC provides class curriculum and assumes no responsibility

other than the opportunity to learn under supervision, and as such | waive any andall

claims that | may have against OPOTC,the Attorney General’s Office, the State of

Ohio, and its employees and agents,including but not limited to any andall liability

claims or demandsfor personal injury, sickness, or death, as well as property

damages and expenses,of any nature whatsoever which may be incurred while

participating in the above referenced program or in any medical procedure arising out

of or related to my participation in such program,including but not limited to any

training conducted at the OPOTC approved school and at any and all state training

locations from any cause whatsoever, including any claims or demands based upon

_negligence.LreleaseOPOTC,theAttorney General’s Office, the State of Ohio,and its

employees and agents, from any and all liability, and | further agree to indemnify the

OPOTC,the Attorney General’s Office, the State of Ohio, and its employees and

agents, from anyloss,liability, damage,or cost, including reasonable attorney's fees,

that may occur due to my participation in the above referenced program or in any

medical procedurearising outof or related to my participation in such program,

whetheror not suchloss,liability, damage, or cost results from the negligence or

other action, except intentional acts. | understand and intend that this release of

liability shall be effective and binding upon myheirs, next of kin executors,

administrators and assigns in the event of my death. Authorization for use or

disclosure of drug screen information.

4. | consent to submit to a drug screen and to furnish a sample of my urine for

analysis to a testing facility designated by the commanderin orderto beeligible

to attend peaceofficer basic training.

2. | authorize and give full permission to have the laboratory orother testing facility

to release any andall documentation relating to such screen to the above listed

commanderor designee.| further agree to and hereby authorize the release of

the results of said tests to the commander,their designee, or the OPOTC.

3. | understand that my sample will be screenedfor the following substances and

concentrations:

Effective 1/1/20218

Initial test analyteInitial test cutoff

concentration Confirmatory test analyteConfirmatory test

cutoff concentration

Marijuana metabolites 50 ng/mL THCA 15 ng/mLCocaine metabolites 150 ng/mL Benzoylecgonine 100 ng/mL

Codeine 2,000 ng/mLCodeine/Morphine 2,000 ng/mL Morphine 2,000 ng/mLHydrocodone 100 ng/mlHydrocodone/Hydromorphone 300 ng/ml Hydromorphone 100 ng/mlOxycodone 100 ng/mlOxycodone/Oxymorphone 100 ng/ml Oxymorphone 100 ng/ml!

6-Acetylmorphine 10 ng/mL 6-Acetylmorphine 10 ng/mLPhencyclidine 25 ng/mL Phencyclidine 25 ng/mL

Amphetamine 250 ng/mLAmphetamine/Methamphetamine! 500 ng/mL Methamphetamine 250 ng/mLMDMA 250 ng/mlMDMA/MDA 500 ng/ml MDA 250 ng/ml

4. | understand that a positive result, refusal to authorize the screensbysigningthisform, failure to take the specified screens, orfailure to produce a specimen maypreclude mefrom attendingthis academy.

5. | understand that | must provide proof within 72 hours ofa positive test that| amtaking a controlled substance as directed pursuant to a lawful prescription issuedin my nameif that substance causes a positive result.

6. | understand that the OPOTC approved schoolis not a covered entity and is notsubject to the privacy requirements of the Health Insurance Portability andAccountability Act of 1996 (HIPAA). | understand that there is a potential thatinformation disclosed to the OPOTC approved school may be subjected toredisclosure by the OPOTC approved school, and not protected from suchredisclosure by federal law orfederal rule.

¢. lunderstand that | may revokethis authorization in writing submitted at any timeto the OPOTC approved school exceptto the extent that action has been taken inreliance on this authorization.If this authorization has not been revoked,it willterminate two years from the date of my signature.

Effective 1/1/2021

Ohio Peace Officer Training CommissionOffice 800-346-7682Fax 740-845-2675

ORNEY Gey,

yo BI NERS,

DAVE YOSsagsi

| LB Py

. { , wt ?

as gt

STUDENT HANDBOOK ACKNOWLEDGMENT AND VERIFICATION

My signature belowindicates that | have received, read and agree to abide by the Ohio RevisedCode, the Ohio Administrative Code, the Peace Officer Basic Training Student Handbook, and theapplicable forms,and thatif any of the information contained in the Handbook needs additionalinformation or explanation, that information or explanation is detailed below.

ADDITIONAL INFORMATION OR EXPLANATION:

(Attach additional documentation,i.e., legal action,if needed)

Student's Name(pleaseprint) Student's Signature Date

Witness Name(pleaseprint) Witness Signature Date

School NameSchool Number

Effective 01/01/2021

feyatt Ohio Peace Officer Training Commission

Office 800-346-7682eFax 740-845-2675

DAVEYOST

OHIO ATTORNEY GENERAL

Family Educational Rights and Privacy Act (FERPA)20 U.S.C. § 1232g; 34 CFR Part 99)

CONSENT TO RELEASE STUDENT INFORMATION

TO ADMINISTRATOR(S) AND/OR STAFF OF:

(College, University, or Career Centerthat will release the educational records)

Please provide information from the educational recordsof:

(NameofStudent requesting the release ofeducational records)to the Ohio Peace Officer Training Commission (OPOTC),

The information to be released underthis consent includes any requested records, other thanmedical records held solely by Student Health Services or the Counseling Center. Theinformation is to be released for the purpose of Ohio Peace Officer Commission oversight of,and communication regarding training programs related to Ohio Administrative Code Chapters109:2-1 through 109:2-18. ;

I understand the information maybe released orally or in the form of copies of written records,photographs, videos, electronic documents, or otherwise, as preferred by the requester. I have aright to inspect any written records released pursuant to this Consent. L understandI may revokethis Consent upon providing written notice to the Commanderofthe OPOTC-approved schoolwith which I am or wasassociated and/or enrolled. I further understand that until this revocationis made, this consent shall remain in effect and my educational records will continue to beprovided to the Ohio Peace Officer Training Commissionfor the purposes described above.

Student Name(print)

(Nameofparent/legal guardian,ifstudentis a minor)

Student Signature

(Signature of parent/legal guardian, if student is a minor)

Student ID Number

Date

SF104unv

Effective 01/01/2021

DAVE \ OS I oroae Ohio Peace Officer Training Commission. Fe, Office 800-346-7682voned = -

OHIO ATTORNEY GENERAL

Student Health Data

Name:Age: Sex: Male Female

Last First Middle

School Name:School Number:

Commander Name: Commander Email:

Do you have any physical or psychological limitations/injuries that might in any way restrict your full participation in physical activities duringtraining?

Yes No Ifyes, please describe:

Student’s SignatureDate

This section to be completed by medical professional (medical doctor (MD), osteopath (DO), physician’s assistant (PA), or certified nursepractitioner (CNP), licensed by the Ohio State Medical Board or the Ohio State Board of Nursing, or a neighboring state’s equivalent, or amedical professional with the US DepartmentofVeterans’ Affairs.): This physical examination should ascertain any conditions which may preclude thestudent’s ability to participate in, or which may be aggravated by, strenuous physical exercise. As

a

part of peaceofficer basic training, the student will engage incalisthenics, running, jumping, wrestling, unarmed self-defense, firearms, driving and other physically demanding exercises,Height: feet inches Weight: pounds Resting Pulse Rate: beats per minute Blood Pressure: /

Doesthe patient have a medical history of, or presently demonstrate symptomsof, any ofthe following?

Yes No Yes No

—_. _..__ 1.

_

Uncorrected visual deficiency —_ —_._._ -9._:~*Dizziness/Fainting—_... ____._2. Major impairmentofthe senses ——. 10, Back/Neckinjury orrecurrent pain_.. _____ 3. Asthmaor Breathingdifficulties —_ ____1II. Pregnancy

—_.. ___._ 4,

_

Heart attack; Angina Pectoris _._ —-_____ 12. Communicable diseases_.. _.Cs‘SS”. Stroke —_._. ___.

_

13. Amputation/Prosthetic devices .__.. -___.__ 6. Hemorrhage —— —— 4. Bone/joint injury or recurrent painss __Ss«S7«.s Hypertension —___ _... 15. Taking medication__s-_SsS88.. Allergies —_ ___._ 16, Underphysician’s continuing care

Please note any other condition(s) not listed above which may affect the student’s participation. Also please explain each “Yes”response above, indicating the itemnumber:

As a result of my physical examination, I have determined that the student can, withoutlimitation, safely function in all phases of strenuous physical trainingincluding, but not limited to, calisthenics, running, jumping, wrestling, unarmed self-defense, firearms, driving and a physical fitness assessment consisting ofsit-ups, push-ups, and a timed 1.5 mile run,

Signature of Medical Professional Printed/Typed Namewith Title (MD, DO, PA or CNP)

License Number Issuing State Phone Number

AddressDate of Examination

City, State, Zip *Please give completed form back to the student to return to thecommanderor sendto the above noted commander’s emailaddress,

SF114bas

Revised 6/16/2020

DAVE YOST .. ·. · . . � .. . :.��;;·•.-.. ,-._, _______ .-. -

01-110 ATTORNlW GENERAL

Ohio Peace Officer Training Commission Office 800-346-7682 Fax 740-845-2675

P.O. Box 309 London, OH 43140 www.Ohio.AttorneyGeneral.gov

REQUEST FOR NATIONAL WEBCHECK®

All information must be typed or printed.

This completed form is to be returned to the commander by the student.

INSTRUCTIONS TO NATIONAL WEBCHECK® FACILITY

• Transaction Type is both BCI and FBI.

• Reason Fingerprinted is "Law Enforcement Employment" or "Law Enforcement/Criminal Justice" for BCIand "Law" for FBI.

• This is a Direct Copy transaction to the Ohio Peace Officer Training Academy (OPOTA). No address needs entered.

TO BE COMPLETED BY STUDENT

I am scheduled to attend an Ohio Peace Officer Training Commission-approved Program to be held at: ___Greene County

Criminal Justice Academy____ beginning on ___09/20/2021_____ _

As part of the enrollment process, the OPOTC requires that I have a criminal record background check conducted within 150 days of the above date by the Ohio Bureau of Criminal Identification (BCI) and the Federal Bureau of Identification (FBI). Therefore, I am requesting a National WebCheck®, IO-digit, for law enforcement purposes.

Name: ___________________________________________ _ (Last) (First) (Middle Name)

Previous Name(s) or Alias:-------------------------------------

Date of Birth: ________________ _ Social Security Number: ____________ _

Address (including P.O. Box, if applicable): _____________________________ _

City: ________________ _ State: ______ _ Zip Code: ________ _

Name of Fingerprinting Agency:------------------------------------

Signature of Person Being Fingerprinted: ________________ _ Date Fingerprinted: _____ _

SF102bns Effective 07/01/2019

GREENECOUNTY PeaceOfficerBasicTraining Application...a GREENECOUNTY “Sess CAREER CENTER”...

Documents

Transcript of GREENECOUNTY PeaceOfficerBasicTraining Application...a GREENECOUNTY “Sess CAREER CENTER”...