| CANDIDATE INFORMATION |
|
| Name: _____ SSN: _____ DOB: _____ |
| Firearms Qualification Date: __________________ Civilian Sworn
Law |
| Enforcement Officer (Y/N)? _____________ Previous deputation for
this |
| purpose (Y/N)? ____ Employing Agency: _____________________ |
| Location (city & state): __________________________________ |
| Employing Agency have a Deadly Force Policy (Y/N)? ______________ |
| _________________________________________________ |
| Name: _____ SSN: _____ DOB: _____ |
| Firearms Qualification Date: __________________ Civilian Sworn
Law |
| Enforcement Officer (Y/N)? _____________ Previous deputation for
this |
| purpose (Y/N)? ____ Employing Agency: _____________________ |
| Location (city & state): __________________________________ |
| Employing Agency have a Deadly Force Policy (Y/N)? ______________ |
| _________________________________________________ |
| Name: _____ SSN: _____ DOB: _____ |
| Firearms Qualification Date: __________________ Civilian Sworn
Law |
| Enforcement Officer (Y/N)? _____________ Previous deputation for
this |
| purpose (Y/N)? ____ Employing Agency: _____________________ |
| Location (city & state): __________________________________ |
| Employing Agency have a Deadly Force Policy (Y/N)? ______________ |
| _________________________________________________ |
| Name: _____ SSN: _____ DOB: _____ |
| Firearms Qualification Date: __________________ Civilian Sworn
Law |
| Enforcement Officer (Y/N)? _____________ Previous deputation for
this |
| purpose (Y/N)? ____ Employing Agency: _____________________ |
| Location (city & state): __________________________________ |
| Employing Agency have a Deadly Force Policy (Y/N)? ______________ |
| _________________________________________________ |
| Name: _____ SSN: _____ DOB: _____ |
| Firearms Qualification Date: __________________ Civilian Sworn
Law |
| Enforcement Officer (Y/N)? _____________ Previous deputation for
this |
| purpose (Y/N)? ____ Employing Agency: _____________________ |
| Location (city & state): __________________________________ |
| Employing Agency have a Deadly Force Policy (Y/N)? ______________ |
| _________________________________________________ |
| Name: _____ SSN: _____ DOB: _____ |
| Firearms Qualification Date: __________________ Civilian Sworn
Law |
| Enforcement Officer (Y/N)? _____________ Previous deputation for
this |
| purpose (Y/N)? ____ Employing Agency: _____________________ |
| Location (city & state): __________________________________ |
| Employing Agency have a Deadly Force Policy (Y/N)? ______________ |
| _________________________________________________ |
|
| Add additional sheets if necessary to list all names. |