Form 2 - Application For Reserve Certification - Colorado Department Of Law
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1APPLICATION FOR
FORM
RESERVE CERTIFICATION
2
Colorado Department of Law
Criminal Justice Section, POST Board
January 2015
th
1300 Broadway 9
Floor
Denver, CO 80203
post@state.co.us
720-508-6721 FAX 866-858-7486
__________________________________________________________________________________________________________________
Last Name
First
Full Middle
__________________________________________________________________________________________________________________
Address
City
State
Zip
______________________________________________________________________________
Aliases
NOTE: All personal information
provided to POST is confidential
Email:_______________________________________________________________________
and will not be released to the
public, pursuant to
Home Telephone: __________________________
Cell: _____________________________
§ 24-72-204, C.R.S.
Colorado Drivers License ________________________
SSN: ______________________
Date of Birth: ____________________________
Gender: M
F
1.
I have successfully completed a POST approved training program. (Attach copy of academy certificate of completion.)
Full Basic Academy
Reserve Academy
2.
I also successfully completed the POST approved training in the following skill areas.
(Attach copies of skills training certificates.)
Arrest Control (required)
Firearms (required)
Driving (optional)
3.
I possess a high school diploma or its equivalent. (Attach copy of diploma or certificate.)
4.
I possess current first aid and cardiopulmonary resuscitation certification (Attach copy showing front and back of each card.)
5.
I have submitted my fingerprints on a POST fingerprint card to the Colorado Bureau of Investigation.
6.
I have not been convicted of any felony or any misdemeanor as referenced in § 24-31-305(1.5), C.R.S.
7.
I am not under investigation or pending investigation for any felony or any misdemeanor as referenced in
§ 24-31-305(1.5), C.R.S.
8.
I have
have not served in the U.S. Military and have not been released or discharged under dishonorable conditions.
(Attach copy of DD-214 Showing Character of Service.)
9.
I am a United States citizen or legal resident and I am lawfully present in the United States
pursuant to Federal Law and § 24-76.5-103, C.R.S., (2007).
10.
I possess a valid Colorado driver’s license or identification card or a United States military card. (Attach copy)
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THIS AFFIDAVIT AND ACCOMPANYING DOCUMENTS, AND TO THE BEST OF
MY KNOWLEDGE AND BELIEF, THEY ARE TRUE, CORRECT, AND COMPLETE. I FURTHER ACKNOWLEDGE THAT ANY FALSE STATEMENT,
MISSTATEMENT, OR INACCURACY MAY RESULT IN REVOCATION OF MY CERTIFICATION, AS WELL AS CRIMINAL PROSECUTION.
Date
_______________________________________________________________
: _______ - _______ - _________
Applicant's Signature
Subscribed and sworn to before me this
day of
_______
____________________, ________________
My Commission Expires: ______--______--__________
_______________________________________________
NOTARY PUBLIC
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