Basic Law Enforcement Academy Equivalency Application

/

Basic Law Enforcement Academy Equivalency Application

/ Return Completed Application To:
Washington State Criminal
Justice Training Commission
19010 1st Ave S.
Burien, WA 98148

Fax: (206) 835-7921
APPLICANT INFORMATION:
ELIGIBILITY: Unless otherwise waived, eligibility to participate in the equivalency process is limited to any full-time commissioned officer that has been certified previously through successful completion of an approved basic law enforcement training program for regular officer in this or any state and has had less than a 60-month break in service. (WAC 139-05-210)
Social Security Number: - -
Name (Last, First MI):
Home Address:
Phone: / Personal E-mail:
Male Female / DOB:
Emergency Contact Name: / Emergency Contact Phone:
Full Time: Reserve: / Relationship:
Rank/Position: / Hire date: / Work E-mail:
Preferred Session Date:
Name of Academy or Basic Training Program Completed:
Certificate of Successful Completion: Yes (attach copy) No (explain)
Last date employed as a fully commissioned Peace Officer:
Driver’s License #: State: Expiration Date:
Criminal Records Check (CJ-1252): Yes SID #: No / Student Liability Release (CJ-1253): Yes (attach) No
Basic First Aid/CPR Card:
Yes (attach) No (explain) / Basic Handgun Course (CJ-1262):
Yes (attach) No (explain)
Emergency Vehicle Operation Training:
Yes No (explain) / # of Hours: / Date of Completion: / Course Location:
AGENCY INFORMATION:
Agency Name: / Agency Phone:
Agency’s Physical Address:
Agency Administrator Name: / Training Officer’s Name:
Rank/Title: / Phone Number:
E-mail Address: / E-mail Address:
Agency Administrator’s Signature: Date:
(Lodging and meal service is provided to academy applicants whose agency is in excess of 40 miles from the Commission)
Check one of the following:
Applicant will require provision of lodging and meal service Applicant will not require provision of lodging and meal service
Applicant will make alternate lodging arrangements, but will require meal service only
FOR COMMISSION STAFF USE ONLY:
Received Date:
Registered Date:
Comments:

Form CJ-1260 Revised 08.18.2015