Step 1: Tell us how to contact you. Required information is in Red.

First Name:		Last Name:
Street address: City: State: ZIP code:
Note: At least one phone number is required.
Home Phone:		Work Phone: Ext.
Cell Phone:		Email:	>> <<
Driver's License #:		Driver's License State:
When is the best time to reach you and which phone number should we use?

Step 2: Fill out this questionnaire.

Please answer all of the following questions:
1. Are you currently TCOLE certified (not required but it reduces the classroom training to 4 weeks)?	Yes No
2. Are you at least 21 years of age (19 1/2 with 60 college hours)?	Yes No
3. Do you have a valid driver's license?	Yes No
4. Are you a US citizen?	Yes No
5. Do you have 45 hours of college or 4 years active military service?	Yes No
6. Have you ever committed a felony or a class A misdemeanor?	Yes No
7. Do you have a conviction for a class B misdemeanor within the last 10 years?	Yes No
8. Have you been convicted for a DWI or a DUI?	Yes No
9. The peace officer training (at no cost to you) will require you attend night classes and some Saturday classes for almost a year. Can you do this?	Yes No
10. Have you ever bought, sold, or used any illegal drugs other than marijuana.	Yes No
11. Is your vision 20/20 or correctable to 20/20 with at least 20/100 in each eye?	Yes No
12. Do you have a problem with color blindness?	Yes No

Please enter any comments or questions below: