Form F-6 Professional Law Enforcement Certificate Application - North Carolina

Form F-6 or the "Professional Law Enforcement Certificate Application" is a form issued by the North Carolina Department of Justice.

The form was last revised in December 1, 2011 and is available for digital filing. Download an up-to-date Form F-6 in PDF-format down below or look it up on the North Carolina Department of Justice Forms website.

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CRIMINAL JUSTICE EDUCATION AND TRAINING STANDARDS COMMISSION
CRIMINAL JUSTICE STANDARDS DIVISION
Post Office Drawer 149, Raleigh, NC 27602
Telephone: (919) 661-5980
Fax (919) 779-8210
Form F-6
(Rev. 12/11)
AWARD FOR PROFESSIONAL LAW ENFORCEMENT CERTIFICATE
INSTRUCTIONS:
1. Please type or print clearly. Attach additional sheets if necessary.
2. This form is to be completed by the applicant and forwarded to his/her agency/department head for Recommendation and
Signature.
3. At the time of application, the applicant MUST be a full-time sworn, paid law enforcement officer and hold General Law
Enforcement Officer Certification.
4. Credit can only be given for full-time, sworn, paid law enforcement experience.
5. Education and training MUST be supported by copies of agency training records, official transcripts, diplomas, or other verifying
documents ATTACHED to this application. All supporting documentation must have a signature of either the Agency Head or
Commission recognized In-Service Training Coordinator. NOTE: Transcripts which are accessed over the internet or intranet are
not official documents.
6. The department head or In-Service Training Coordinator will then forward the completed form and attachments to the Criminal
Justice Standards Division for processing.
7. Action on the application will be reported directly to the applicant=s department head/applicant.
FOR COMMISSION STAFF USE ONLY
Received:
________________ Processed:
_____________
Evaluating Official:
______________________________
Certified:
Yes
No
Full-time officer, currently employed:
Yes
No
Attest to Code of Ethics:
Yes
No
Recommended by Agency Head:
Yes
No
Points Computation:
Education Points: _____________
Degree: ______________________________________________
Training Points:
____________
_____________________________________________
Total Points:
____________
_____________________________________________
Years of Creditable Experience:
___________________
Recommended Issuance of
__________________
Intermediate ___________________ Advanced
Date of Certificate Issued:
__________________
Intermediate ___________________ Advanced
To Be Completed by Applicant
Name to Appear on Certificate
(Please Type or Print)
________________________________________________________________________
Applicant=s Home Address: ___________________________________________________________________________________
Street
Zip Code
Employing Agency: ______________________________________________ Phone#:
___________________________________
Agency Mailing Address:
___________________________________________________________________________________
Street
Zip Code
Rank/ Title:
_______________________________ Date of Birth: _________________
Application for:
Intermediate Certificate
Advanced Certificate
CRIMINAL JUSTICE EDUCATION AND TRAINING STANDARDS COMMISSION
CRIMINAL JUSTICE STANDARDS DIVISION
Post Office Drawer 149, Raleigh, NC 27602
Telephone: (919) 661-5980
Fax (919) 779-8210
Form F-6
(Rev. 12/11)
AWARD FOR PROFESSIONAL LAW ENFORCEMENT CERTIFICATE
INSTRUCTIONS:
1. Please type or print clearly. Attach additional sheets if necessary.
2. This form is to be completed by the applicant and forwarded to his/her agency/department head for Recommendation and
Signature.
3. At the time of application, the applicant MUST be a full-time sworn, paid law enforcement officer and hold General Law
Enforcement Officer Certification.
4. Credit can only be given for full-time, sworn, paid law enforcement experience.
5. Education and training MUST be supported by copies of agency training records, official transcripts, diplomas, or other verifying
documents ATTACHED to this application. All supporting documentation must have a signature of either the Agency Head or
Commission recognized In-Service Training Coordinator. NOTE: Transcripts which are accessed over the internet or intranet are
not official documents.
6. The department head or In-Service Training Coordinator will then forward the completed form and attachments to the Criminal
Justice Standards Division for processing.
7. Action on the application will be reported directly to the applicant=s department head/applicant.
FOR COMMISSION STAFF USE ONLY
Received:
________________ Processed:
_____________
Evaluating Official:
______________________________
Certified:
Yes
No
Full-time officer, currently employed:
Yes
No
Attest to Code of Ethics:
Yes
No
Recommended by Agency Head:
Yes
No
Points Computation:
Education Points: _____________
Degree: ______________________________________________
Training Points:
____________
_____________________________________________
Total Points:
____________
_____________________________________________
Years of Creditable Experience:
___________________
Recommended Issuance of
__________________
Intermediate ___________________ Advanced
Date of Certificate Issued:
__________________
Intermediate ___________________ Advanced
To Be Completed by Applicant
Name to Appear on Certificate
(Please Type or Print)
________________________________________________________________________
Applicant=s Home Address: ___________________________________________________________________________________
Street
Zip Code
Employing Agency: ______________________________________________ Phone#:
___________________________________
Agency Mailing Address:
___________________________________________________________________________________
Street
Zip Code
Rank/ Title:
_______________________________ Date of Birth: _________________
Application for:
Intermediate Certificate
Advanced Certificate
Acceptable Training Types:
 Law Enforcement Experience (list full time, sworn, paid experience ONLY).
 Out-of-State Experience MUST be documented by original letter from previous agency head.
 Military Police Experience MUST be documented by DD-214.
Unacceptable Training Types: (do NOT include on list)
 24 hours of annual Mandatory In-Service Training (includes Department Choice topics).
 Training of less than one hour.
 Basic Law Enforcement Training.
Agency Name & Location
Dates of Full-Time, Sworn Employment
________________________________________________________
_________________________________________
________________________________________________________
_________________________________________
________________________________________________________
_________________________________________
________________________________________________________
_________________________________________
________________________________________________________
_________________________________________
Law Enforcement Training (Attach training documentation i.e.; certificate of completion, transcripts, or department training records)
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
College Education (Must provide copy of official transcript or diploma)
Name of College
Location(City/State)
Dates Attended
Semester Hours
Degree
______________________________ ________________________ _____________________ ____________________ _______________
______________________________ ________________________ _____________________ ____________________ _______________
______________________________ ________________________ _____________________ ____________________ _______________
______________________________ ________________________ _____________________ ____________________ _______________
Attest:
I attest that I have read and subscribe to the Law Enforcement Code of Ethics. The information contained in this application
is true and correct to the best of my knowledge.
Date:
Signature of Applicant
__________________
: ____________________________________________________________________
Recommendation:
It is recommended that the Certificate be awarded. I certify that, to the best of my knowledge, the applicant has complied with
the Commission=s Regulations, is of good moral character and is worthy of the award. My opinion is based upon personal
knowledge or inquiry, and the personnel records of this jurisdiction substantiate the recommendation.
_______________________________________________________________________________________________________
Date
Printed Name of Agency Head/In-Service Training Coordinator
Signature
Form F-6 Rev. 12/11

Download Form F-6 Professional Law Enforcement Certificate Application - North Carolina

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