Form F-5 "Application for Basic Training" - Alaska

Form F-5 is a Alaska Department of Public Safety form also known as the "Application For Basic Training". The latest edition of the form was released in June 1, 2017 and is available for digital filing.

Download a PDF version of the Form F-5 down below or find it on Alaska Department of Public Safety Forms website.

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Alaska Police Standards Council
PO Box 111200
Juneau, AK 99811-1200
Ph: 907 465-4378
F-5
APPLICATION FOR BASIC TRAINING
CHECK ONE:
ACADEMY:
Police
Correctional
Probation/Parole
APSC Recert Dates:
ACADEMY:
ACADEMY:
ACADEMY:
ALET Dates:
APD Dates:
UAF CTC Dates:
ACADEMY:
ACADEMY:
Correctional
Probation/Parole Dates:
Municipal Correctional Dates:
Last, First, Middle
Name (
)
Agency:
Date of Birth:
Agency Address:
Rank:
Vehicle Operator’s License Number:
Expiration Date:
Height:
Weight:
Date of Hire:
Date of Last Physical Examination:
Limitations Indicated by Physical Exam:
Current Assignment:
Previous Basic Law Enforcement Training:
T h e f o l l o w i n g d o c u m e n t s m u s t a c c o m p a n y t h i s a p p l i c a t i o n ( u n l e s s p r e v i o u s l y p r o v i d e d t o A P S C ) .
A. Health Questionnaire (F-2A)
B. Medical Exam Report (F-2B)
C. Personal History Statement (F-3)
D. Psychological Examination Report (F-11, unless an M.C.O.)
APPLICANT
2. Have you ever been convicted of a felony or a crime,
which limits or prevents you from possessing a firearm?
1. Have you ever been convicted of a firearms violation?
Yes
No
Yes
No
I release the sponsoring agency and other departments officially connected or associated with this training program from liability in case of
illness or accident. I acknowledge that information contained on this form will be used by the council for purposes of determining my
eligibility and qualifications for training, employment, and certification.
I swear and affirm, under penalty or PERJURY, that the foregoing is true and accurate to the best of my knowledge.
Done at ____________________________________ , Alaska on the ___________day of _______________________________, 20_______.
SWORN TO AND SUBSCRIBED before me on this
____________day of __________________, 20_______.
Applicant_______________________________________
______________________________________________
Notary Public in and for Alaska
My Commission Expires:__________________________
DEPARTMENT HEAD
I certify that this applicant has met the minimum employment standards and approve this application.
________________________________________________
_____________________________
______________________________
Department Head Signature
Printed Name/Title
Date
APSC Use:
APSC 6/01/2017
1
Alaska Police Standards Council
PO Box 111200
Juneau, AK 99811-1200
Ph: 907 465-4378
F-5
APPLICATION FOR BASIC TRAINING
CHECK ONE:
ACADEMY:
Police
Correctional
Probation/Parole
APSC Recert Dates:
ACADEMY:
ACADEMY:
ACADEMY:
ALET Dates:
APD Dates:
UAF CTC Dates:
ACADEMY:
ACADEMY:
Correctional
Probation/Parole Dates:
Municipal Correctional Dates:
Last, First, Middle
Name (
)
Agency:
Date of Birth:
Agency Address:
Rank:
Vehicle Operator’s License Number:
Expiration Date:
Height:
Weight:
Date of Hire:
Date of Last Physical Examination:
Limitations Indicated by Physical Exam:
Current Assignment:
Previous Basic Law Enforcement Training:
T h e f o l l o w i n g d o c u m e n t s m u s t a c c o m p a n y t h i s a p p l i c a t i o n ( u n l e s s p r e v i o u s l y p r o v i d e d t o A P S C ) .
A. Health Questionnaire (F-2A)
B. Medical Exam Report (F-2B)
C. Personal History Statement (F-3)
D. Psychological Examination Report (F-11, unless an M.C.O.)
APPLICANT
2. Have you ever been convicted of a felony or a crime,
which limits or prevents you from possessing a firearm?
1. Have you ever been convicted of a firearms violation?
Yes
No
Yes
No
I release the sponsoring agency and other departments officially connected or associated with this training program from liability in case of
illness or accident. I acknowledge that information contained on this form will be used by the council for purposes of determining my
eligibility and qualifications for training, employment, and certification.
I swear and affirm, under penalty or PERJURY, that the foregoing is true and accurate to the best of my knowledge.
Done at ____________________________________ , Alaska on the ___________day of _______________________________, 20_______.
SWORN TO AND SUBSCRIBED before me on this
____________day of __________________, 20_______.
Applicant_______________________________________
______________________________________________
Notary Public in and for Alaska
My Commission Expires:__________________________
DEPARTMENT HEAD
I certify that this applicant has met the minimum employment standards and approve this application.
________________________________________________
_____________________________
______________________________
Department Head Signature
Printed Name/Title
Date
APSC Use:
APSC 6/01/2017
1
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