Basic Law Enforcement - Ogeechee Technical College

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)
ƒ 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.
Updated: 01/24/11
PH
HASE I – Co
ollegee Adm
missions All in
nformation in PHASE I must be co
ompleted beffore an appllicant can move
m
to
PHA
ASE II.
F Complete
C
thee Applicatio
on for Admission and su
ubmit with a one-time nonn
reefundable $2
20.00 appliccation fee to
o the addresss below. Wee encouragee you to
ap
pply online at www.ogeecheetech..edu. Note: All
A applican
nts must be 18 years of
agge or older and
a have a high
h
school diploma or GED.
F Su
ubmit an OFFICIAL
OF
co
opy of your high
h
school transcript or
o GED scorres. The
trranscripts orr test scores must be sen
nt directly to
t the Admisssions Office in a sealed
d
en
nvelope from
m the issuin
ng school orr testing cen
nter.
F Su
ubmit
OFFIICIAL copiees of any posstsecondary college andd/or technicaal college
trranscripts. These
T
should
d be sent dirrectly to thee Admission
ns Office in a sealed
en
nvelope from
m the issuin
ng school.
F You
Y must eitther:
- Provide CO
OMPASS tesst results (5 years
y
old orr less),
on above:
Iff you cannott submit thee informatio
- Contact thee Admission
ns Office to schedule
s
an
nd take the COMPASS
C
p
placement
exxam. My exam
e
is scheduled for ____________________________.
F Apply
A
for Fin
nancial Aid.. You may pick
p
up form
ms and inform
mation on HOPE,
H
PELL
L,
VA or other financial aid
V
d at our Financial Aid Office.
O
Addiitional inforrmation is
av
vailable online at www
w.ogeecheeteech.edu.
F Once
O
you com
mplete yourr PHASE I enrollment
e
p
process,
you
u will receiv
ve
notification via
n
v mail. At this point, you
y will be able to subm
mit all requiired
documentatio
on in PHASSE II.
The in
nformation in
i PHASE I should be sub
bmitted to:
Admissiions Office
O
Ogeechee
Technical Colleege
One Joe Kennedy Blvd
d
Statesboro
o, GA 30458
u
Website: www.ogeeecheetech.edu
Telephone: (912) 688--6994
(800) 646--1316
F number: (912) 486--7413
Fax
Updaated: 01/24/11
PH
HASE II – P
POST A
Appro
oval
Oncee you have received
r
you
ur letter from
m Admissio
ons confirmiing that you
u have
comp
pleted Phasee I, you willl need to sub
bmit the folllowing to th
he Law Enfo
orcement
Acad
demy: NOTE
E: Please seee the additio
onal informaation page fo
or guidancee on the
follow
wing items (located in this
t packet).
F Su
ubmit a cop
py of your leetter confirm
ming compleetion of Phaase I.
F Complete
C
thee Basic Law Enforcement Applicatiion (Pre-serrvice Appliccation). This
fo
orm may be found onlin
ne at http://w
www.ogeeccheetech.edu
u/admission
ns. A $150
ap
pplication feee will be reequired with
h your appliication when it is sent to
t POST.
F Complete
C
thee backgroun
nd investigattion form
o
Go
o to www.p
psibackgroun
ndcheck.com
m and subm
mit informatiion for
baackground investigatio
on. There iss a $165.00 non-refund
n
able fee thaat
must
m be paid via credit caard or moneey order (maailed to the address
lissted on website).
F You
Y must sub
bmit an origginal certifieed copy of your
y
birth ceertificate OR
R a valid
Georgia driveer’s license AND
G
A
one off the docum
ments listed on
o page 5 an
nd appendixx
9 of the Peacce Officer Accademy App
plication.
F Su
ubmit a stan
ndard size passport photo
F Iff applicable,, submit Me
ember copy of
o military discharge
d
paapers (DD2114)
F Su
ubmit fingeerprints thro
ough Georgiia Applicantt Processing Service (seee GAPS form
m
in
nside this paacket). You can not submit fingerprrint cards.
F Complete
C
and submit ressults of a ph
hysical exam
mination. Th
he physician
n must utilize
th
he Physician
n’s Affidavitt supplied in
n this packett as part of the
t Basic Laaw
E
Enforcement
t application
n (begins on
n page 11 of Pre-service Application
n)
The information
i
n in PHASE II should bee sent by maail or hand delivered
d
to
o:
Laaw Enforcem
ment Acadeemy
O
Ogeechee
Tecchnical Colllege
107 Duval Street
Claxton, GA 30417
T
Telephone:
(912) 739.5367
Faax number:
(912) 739-5366
Remiinder: YOU
U are respon
nsible for en
nsuring thatt your appliication is coomplete!
Updaated: 01/24/11
•
•
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.
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.
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, etc
15. 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.
Page 8- 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.
Updated: 01/24/11
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 Position
Pre-Service
Candidate for
Peace Officer
Candidate’s First Name
Candidate’s Middle Name
Give suffix (such as Jr. , Sr., II, III, IV, V, etc.) :
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)
WEIGHT
HEIGHT
ft
in
HAIR
COLOR
lbs
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
Page 9 Driver Hist
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
___
___
___
___
___
___
___
___
___
Page 10 Criminal History
Page 11 Printout/FPs
Page 12 Attestation
Physician’s Affidavit
DD214 form
Discharge explanation
Entrance Exam Results
GCIC/NCIC Printout
Driver’s History
Georgia Peace Officer Standards & Training Council
Pre-Service Application for Certification
Pg __
Of __
Initial
____
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.
Place
Photograph
Here
________________________________________
Candidate Signature
Date
________________________________________
Agency Head or Authorized Representative Signature
Georgia Peace Officer Standards & Training Council
Pre-Service Application for Certification
Pg __
Of __
Initial
____
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.
Last Name
DATE OF BIRTH
First Name
Middle Name
MAIDEN NAME
PHONE NUMBER
(mdyyyy)
(AREA CODE) - NUMBER
(
)-
-
Social Security Number:
Email Address
@
ADDRESS: Street
City:
Apartment/Unit#
State:
____________________________________________
Candidate Signature (including maiden name)
____________________________________________
Notary Public Signature
-
Zip Code:
_________________
Date
_________________
Date
Georgia Peace Officer Standards & Training Council
Pre-Service Application for Certification
Pg __
Of __
Initial
____
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:
Name of Interviewer (First Last)
(mm/dd/yyyy)
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. § 358-8, 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
Georgia Peace Officer Standards & Training Council
Pre-Service Application for Certification
Pg __
Of __
Initial
____
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)
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?
Is the candidate a naturalized citizen?
Yes
Yes
No
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
Georgia Peace Officer Standards & Training Council
Pre-Service Application for Certification
Pg __
Of __
Initial
____
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).
Georgia Peace Officer Standards & Training Council
Pre-Service Application for Certification
Pg __
Of __
Initial
____
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):
Navy
National Guard
Air Force
Army
Coast Guard
Marines
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)
FROM (MONTH/YEAR)
TO (MONTH/YEAR)
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).
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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?
(If YES, list state & certification #’s. Use appendix 6 for additional listings if necessary.)
STATE (Ex. GA):
CERTIFICATION#
STATE (Ex. GA):
CERTIFICATION#
Yes
No
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:
Agency Name:
State:
Employed from (mo/yr)
to:
Position held:
Reason for leaving:
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.
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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?
Has candidate ever had their license suspended?
Year:
DUI/DWI
Points
Yes
No
Yes (If yes, check which reason and give year)
Insurance related
Other
No
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
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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:
Has the candidate ever been arrested?
Yes
No
Yes If Yes, complete this section.
Has the candidate ever been convicted of a felony?
Yes
No If No, go to the Next Section.
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
CONVICTED:
Yes
No
CHARGE (pick from list, if not on list provide below)
Check all that apply:
Fine
If not on list, give charge:
Amount:
DISPOSITION:
Time(mos/yrs):
Probation
Incarceration
Time(mos/yrs):
If OTHER, give disposition below:
DATE OF
ARREST
m/d/yyyy
Community Service
ARRESTING AGENCY
CONVICTED:
Yes
No
CHARGE (pick from list, if not on list provide below)
Check all that apply:
Fine
If not on list, give charge:
Amount:
DISPOSITION:
Time(mos/yrs):
Probation
Incarceration
Time(mos/yrs):
If OTHER, give disposition below:
Attachments:
Police Incident Report
Community Service
Court Disposition
Signed/Notarized Statement re: incident
Candidate’s Last Name
Information verified by Candidate: _______________________________________________________
Candidate’s Signature
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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
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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
Social Sec#
DATE OF
BIRTH
(mm/dd/yyyy)
Last Name
Suffix:
Maiden Name
First Name
HEIGHT
ft
in
Middle Name
WEIGHT
lbs
SEX:
(without shoes
& coat)
This individual is a candidate for Peace Officer Certification in Georgia.
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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
Describe additional tests or information required prior to making final determination.
Indeterminate
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
Describe additional tests or information required prior to making final determination.
Indeterminate
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.
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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)
DATE (m/d/yyyy)
____________________________________________________
First
Last
ADDRESS OF LICENSED EXAMINING PHYSICIAN’S PRACTICE
Phone:
Area Code+Number
________________________________________________________________________
(
Street
)
________________________________________________________________________
City, State, Zip
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)
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.
DATE
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] .
STEP 3:
©Professional Screening & Information, Inc. 2008
Professional Screening & Information, Inc.
P.O. Box 644
Rome, Georgia 30162
www.psibackgroundcheck.com
Call PSI at (706) 235-7574
Questions or comments?
Acknowledgment and payment.
After completing all required information,
read the acknowledgment page, check the
appropriate boxes and enter the date for
your electronic signature.
The fee for the background investigation is
$165.00. Payment is accepted via credit
card. Please follow the instructions to
complete your payment.
You’re done!!
After PSI recieves your payment, the
background investigation will be completed
within three to five days. During this
period, feel free to login and check the
status of your background investigation.
Once complete, each user has fourteen
days to download and/or print a copy for
retention. Additionally, maintaining
continuous enrollment at this school,
provides each user the ability to change an
unlimited number of times the client/clinical
site which can view a background
investigation. This can be done from the
“Your Background Check Information”
screen, when returning users login.
Online Background Check
Process Overview
For students of…
Ogeechee Technical College
Law Enforcement Academy
To initiate a background investigation
for your school through Professional
Screening & Information (“PSI”), it’s as
simple as 1…2…3, and you are done!
STEP 1:
•
•
Select the Individual “Enter” button.
Access our website at
www.psibackgroundcheck.com.
Create an account and enter personal
information or login.
•
•
Returning users should login using the
information used when their account was
established.
New users should create an account and
then enter required personal information.
•
If a user forgets their password, select
the “Forgot Password” button and after
answering your security questions, the
user’s password will be emailed to the
address on record.
STEP 2:
•
•
•
•
•
•
Select the clients or clinical site that will
need access to the background
Select the program for which the
background investigation is requested.
Select the location or campus attending.
Enter the school’s organization code,
which is CUST_84.
Enter the package code for the
background composition the school has
selected, which is PP1.
Then, select the “Applicant” type of
background. Ogeechee Technical
College Law Enforcement Academy
students should not choose the
“Individual” type.
After creating an account or to initiate
another background investigation, on
the next screen select the background
type tab (if not already displayed).
Selecting background type and
completing required information.
•
investigation. To select multiple, press
and hold control while selecting.
•
If you do not know your clients/clinical
sites at this time, leave this blank. You
will be able to edit this later, when you
have the necessary information.
•
•
•
Save each set of responses for an entry
prior to selecting done.
After an entry is complete, re-read
responses to ensure spelling and format
are correct.
All fields are required to be completed.
After completing the background type,
complete all required information. Some
key points to remember are:
•
There are suggested requirements for
the amount of information to be supplied
(i.e. years of residency history), be as
complete as possible when answering
these questions.
(over)