Form F-9a "Firearms Qualification Record" - North Carolina

Form F-9A or the "Firearms Qualification Record" is a form issued by the North Carolina Department of Justice.

The form was last revised in January 1, 2018 and is available for digital filing. Download an up-to-date Form F-9A in PDF-format down below or look it up on the North Carolina Department of Justice Forms website.

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C
J
E
A
T
S
C
RIMINAL
USTICE
DUCATION
ND
RAINING
TANDARDS
OMMISSION
HERIFFS’
C
S
E
A
T
S
C
N
ORTH
AROLINA
DUCATION
ND
RAINING
TANDARDS
OMMISSION
Sheriffs’ Standards Division
Criminal Justice Standards Division
PO Box 629
Post Office Drawer 149
Raleigh, NC 27602
Raleigh, NC 27602
Telephone: (919) 779-8213
Telephone: (919) 661-5980
Fax: (919) 662-4515
Fax: (919) 779-8210
(rev. 01.18)
F
Q
R
I
IREARMS
UALIFICATION
ECORD
NSTRUCTIONS
Form F-9A
This form must be utilized to record the annual In-Service Firearms Training and Qualification for each certified officer in compliance with 12 NCAC 9E
.0100 or 12 NCAC 10B .2104. A copy must be maintained in each officer’s personnel file at the employing agency, and must be available for inspection by a
Commission Staff member. A copy must be attached to the F-5A and submitted to the Criminal Justice Standards Division for all new hires.
SECTION I:
Must be completed for every officer.
SECTION II:
Must be completed for every officer and signed and dated by the instructor(s).
Must be signed and dated by the officer.
SECTION III:
SECTION IV:
Must be signed and dated by the Agency Head or designated representative.
SECTION V:
Must be completed and signed by the specific certified Specialized Firearms Instructor(s).
OFFICER’S NAME:__________________________________________________
I.
SSN (Last 4):____________________________
Certified by: NC Criminal Justice Education and Training Standards Commission:
Yes
No
Certified by: NC Sheriffs’ Education and Training Standards Commission:
Yes
No
EMPLOYING/APPOINTING AGENCY:________________________________________________________________________________________
FIREARMS INSTRUCTOR COMPLIANCE – CLASSROOM REQUIREMENT
II.
As a Specialized Firearms Instructor, I do hereby certify that the officer listed above has completed the mandatory classroom portion of the in-service
firearms training, as specified in 12 NCAC 9E .0105 or 12 NCAC 10B .2103 as applicable. Failure to complete this training requires that the agency head or
designated representative be notified.
The classroom session was completed on _________________________(date).
_______________________________
______________________________
_____________
____________________
Print Name of Firearms Instructor
Signature of Firearms Instructor
Instructor #
Date Signed
III.
ACKNOWLEDGEMENT OF QUALIFICATION SCORES:
I do hereby certify that I have been advised of my firearms qualification scores by the Specialized Firearms Instructor(s) indicated. I also understand that if I
have failed to qualify with any weapons(s) required, I may not carry and/or have access to the weapon until such time as I have qualified. I further
understand that I must notify my agency head or designated representative within 24 hours of my failure to qualify, and/or successfully complete the training
portion as prescribed in 12 NCAC .9E .0105 or 12 NCAC 10B .2103 as applicable.
_______________________________________________
____________________
Signature of Officer
Date Signed
IV.
AGENCY ACKNOWLEDGEMENT OF QUALIFICATION SCORES:
As agency head, or designated representative, the below signature acknowledges receipt of the above officer’s qualification scores and attests that the above
officer has satisfactorily completed training on this department’s policies regarding the use of force, N.C. State law regarding the use of deadly force,
relevant case law, and safety and marksmanship as required in 12 NCAC 9E .0105 or 12 NCAC 10B .2103. I understand that if the officer has failed to
qualify with any weapon(s), then I must restrict access to all applicable weapon(s) until such time as the officer has qualified with same.
I certify that the in-service firearms training consisted of a minimum of four (4) hours/credits (For Criminal Justice Commission only.)
_______________________________________________
___________________
Signature of Agency Head/Designated Representative
Date Signed
Page 1 of 2
C
J
E
A
T
S
C
RIMINAL
USTICE
DUCATION
ND
RAINING
TANDARDS
OMMISSION
HERIFFS’
C
S
E
A
T
S
C
N
ORTH
AROLINA
DUCATION
ND
RAINING
TANDARDS
OMMISSION
Sheriffs’ Standards Division
Criminal Justice Standards Division
PO Box 629
Post Office Drawer 149
Raleigh, NC 27602
Raleigh, NC 27602
Telephone: (919) 779-8213
Telephone: (919) 661-5980
Fax: (919) 662-4515
Fax: (919) 779-8210
(rev. 01.18)
F
Q
R
I
IREARMS
UALIFICATION
ECORD
NSTRUCTIONS
Form F-9A
This form must be utilized to record the annual In-Service Firearms Training and Qualification for each certified officer in compliance with 12 NCAC 9E
.0100 or 12 NCAC 10B .2104. A copy must be maintained in each officer’s personnel file at the employing agency, and must be available for inspection by a
Commission Staff member. A copy must be attached to the F-5A and submitted to the Criminal Justice Standards Division for all new hires.
SECTION I:
Must be completed for every officer.
SECTION II:
Must be completed for every officer and signed and dated by the instructor(s).
Must be signed and dated by the officer.
SECTION III:
SECTION IV:
Must be signed and dated by the Agency Head or designated representative.
SECTION V:
Must be completed and signed by the specific certified Specialized Firearms Instructor(s).
OFFICER’S NAME:__________________________________________________
I.
SSN (Last 4):____________________________
Certified by: NC Criminal Justice Education and Training Standards Commission:
Yes
No
Certified by: NC Sheriffs’ Education and Training Standards Commission:
Yes
No
EMPLOYING/APPOINTING AGENCY:________________________________________________________________________________________
FIREARMS INSTRUCTOR COMPLIANCE – CLASSROOM REQUIREMENT
II.
As a Specialized Firearms Instructor, I do hereby certify that the officer listed above has completed the mandatory classroom portion of the in-service
firearms training, as specified in 12 NCAC 9E .0105 or 12 NCAC 10B .2103 as applicable. Failure to complete this training requires that the agency head or
designated representative be notified.
The classroom session was completed on _________________________(date).
_______________________________
______________________________
_____________
____________________
Print Name of Firearms Instructor
Signature of Firearms Instructor
Instructor #
Date Signed
III.
ACKNOWLEDGEMENT OF QUALIFICATION SCORES:
I do hereby certify that I have been advised of my firearms qualification scores by the Specialized Firearms Instructor(s) indicated. I also understand that if I
have failed to qualify with any weapons(s) required, I may not carry and/or have access to the weapon until such time as I have qualified. I further
understand that I must notify my agency head or designated representative within 24 hours of my failure to qualify, and/or successfully complete the training
portion as prescribed in 12 NCAC .9E .0105 or 12 NCAC 10B .2103 as applicable.
_______________________________________________
____________________
Signature of Officer
Date Signed
IV.
AGENCY ACKNOWLEDGEMENT OF QUALIFICATION SCORES:
As agency head, or designated representative, the below signature acknowledges receipt of the above officer’s qualification scores and attests that the above
officer has satisfactorily completed training on this department’s policies regarding the use of force, N.C. State law regarding the use of deadly force,
relevant case law, and safety and marksmanship as required in 12 NCAC 9E .0105 or 12 NCAC 10B .2103. I understand that if the officer has failed to
qualify with any weapon(s), then I must restrict access to all applicable weapon(s) until such time as the officer has qualified with same.
I certify that the in-service firearms training consisted of a minimum of four (4) hours/credits (For Criminal Justice Commission only.)
_______________________________________________
___________________
Signature of Agency Head/Designated Representative
Date Signed
Page 1 of 2
**As a certified Specialized Firearms Instructor, I hereby certify that the officer listed below has attained the score(s) as documented below. I understand that if the officer has failed
to qualify, then I must deliver a copy of this form to the officer’s agency head or designated representative within 72 hours either in person, or by certified mail.**
OFFICER’S NAME: ______________________________________ NAME OR RANGE LOCATION: ____________________________________________ F-9A (rev. 01.18)
V. SERVICE HANDGUN QUALIFICATION
Date
Weapon
Make
Model
Caliber or
Serial #
Ammunition
Day(D)
Score
Qualify
Type
Gauge
Night(N)
(%) or
Yes/No
Print and Sign Name & Instructor Number
(P)(F)
1.
2.
3.
4.
OFF-DUTY HANDGUN QUALIFICATION
Date
Weapon
Make
Model
Caliber or
Serial #
Ammunition
Day(D)
Score (%)
Qualify
Print and Sign Name & Instructor Number
Type
Gauge
Night(N)
(P)(F)
Yes/No
1.
2.
3.
4.
SHOTGUN/RIFLE QUALIFICATION
Date
Weapon
Make
Model
Caliber or
Serial #
Ammunition
Day(D)
Score (%)
Qualify
Print and Sign Name & Instructor Number
Type
Gauge
Night(N)
(P)(F)
Yes/No
1.
2.
AUTOMATIC/SPECIALTY WEAPONS/OTHER
Date
Weapon
Make
Model
Caliber or
Serial #
Ammunition
Day(D)
Score (%)
Qualify
Print and Sign Name & Instructor Number
Type
Gauge
Night(N)
(P)(F)
Yes/No
1.
2.
COMBAT COURSE
Date
Day/Night
Pass/Fail
Comments
Print and Sign Name & Instructor Number
1.
2.
R-Revolver
S&W- Smith & Wesson
BEN-Benelli
BRO- Browning
SW- Specialized Weapon
Ammunition- Must be duty ammunition or ballistic equivalent ammunition.
H&K – Heckler & Koch
SA- Semi Auto Handgun
GLO - Glock
CLT - Colt
SPF -Springfield
Include sufficient information to fully describe such as caliber, projectile weight and type.
RRV – Rock River
*Sheriff’s Standards handgun night requires use of flashlight at the 5-yd line
SG- Shotgun
BER- Beretta
WIN- Winchester
MOS- Mossberg
REM – Remington
*Sheriff’s Standards accepts pass/fail rather than % scores
AW- Automatic Weapon
RUG- Ruger
ARA - Armalite
BUS – Bushmaster
Page 2 of 2
RF- Rifle
SIG- Sig Sauer
SAV - Savage
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