Form A "Crime Prevention Specialist Certification Application" - Virginia

What Is Form A?

This is a legal form that was released by the Virginia Department of Criminal Justice Services - a government authority operating within Virginia. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2013;
  • The latest edition provided by the Virginia Department of Criminal Justice Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form A by clicking the link below or browse more documents and templates provided by the Virginia Department of Criminal Justice Services.

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Download Form A "Crime Prevention Specialist Certification Application" - Virginia

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Commonwealth of Virginia
Virginia Department of Criminal Justice Services
Crime Prevention Specialist CERTIFICATION
Application (Form A)
Applicant’s Name
E-Mail:
Title:
Employing Agency:
Address:
Name of Law Enforcement/Criminal Justice Agency Chief Executive Officer or Designee:
Signature:
Date:
Phone #:
Have you been certified by DCJS as a General Law Enforcement Instructor within the past five (5) years?
Yes
No
If you answered “NO”, have you completed a comparable instructor development course?
Yes
No
If YES, list type of course, dates of attendance, and who provided training
Dates
Hours
Training Provided By:
Dates
Hours
Training Provided By:
Have you completed forty (40) hours of introductory crime prevention training?
If YES, when and where did you complete your training:
Yes
No
Dates
Hours
Training Provided By:
Dates
Hours
Training Provided By:
Have you received eighty (80) hours of additional crime prevention training in the past five (5) years?
Yes
No
If YES, list type of course, dates of attendance, and who provided training
Dates
Hours
Training Provided By:
Dates
Hours
Training Provided By:
Do you have at least three (3) years of experience working in a criminal justice agency?
Yes
No
If YES, please list experience
Dates
Agency:
Dates
Agency:
Do you have at least one (1) year of experience, within past 5 years in providing crime prevention services?
Yes
No
Do you possess a crime prevention related designation from a nationally recognized organization or from another state?
Yes
No If yes, please provide the following:
Designation Name:
Designating Organization or state:
Date Issued:
PLEASE ATTACH DOCUMENTATION FOR ALL COMPLETED TRAINING TO THIS APPLICATION AND RETURN TO:
Virginia Department of Criminal Justice Services, Attn: Crime Prevention Coordinator
1100 Bank Street, 9th Floor, Richmond, VA 23219
Virginia Department of Criminal Justice Services
www.dcjs.virginia.gov
November 2013
Commonwealth of Virginia
Virginia Department of Criminal Justice Services
Crime Prevention Specialist CERTIFICATION
Application (Form A)
Applicant’s Name
E-Mail:
Title:
Employing Agency:
Address:
Name of Law Enforcement/Criminal Justice Agency Chief Executive Officer or Designee:
Signature:
Date:
Phone #:
Have you been certified by DCJS as a General Law Enforcement Instructor within the past five (5) years?
Yes
No
If you answered “NO”, have you completed a comparable instructor development course?
Yes
No
If YES, list type of course, dates of attendance, and who provided training
Dates
Hours
Training Provided By:
Dates
Hours
Training Provided By:
Have you completed forty (40) hours of introductory crime prevention training?
If YES, when and where did you complete your training:
Yes
No
Dates
Hours
Training Provided By:
Dates
Hours
Training Provided By:
Have you received eighty (80) hours of additional crime prevention training in the past five (5) years?
Yes
No
If YES, list type of course, dates of attendance, and who provided training
Dates
Hours
Training Provided By:
Dates
Hours
Training Provided By:
Do you have at least three (3) years of experience working in a criminal justice agency?
Yes
No
If YES, please list experience
Dates
Agency:
Dates
Agency:
Do you have at least one (1) year of experience, within past 5 years in providing crime prevention services?
Yes
No
Do you possess a crime prevention related designation from a nationally recognized organization or from another state?
Yes
No If yes, please provide the following:
Designation Name:
Designating Organization or state:
Date Issued:
PLEASE ATTACH DOCUMENTATION FOR ALL COMPLETED TRAINING TO THIS APPLICATION AND RETURN TO:
Virginia Department of Criminal Justice Services, Attn: Crime Prevention Coordinator
1100 Bank Street, 9th Floor, Richmond, VA 23219
Virginia Department of Criminal Justice Services
www.dcjs.virginia.gov
November 2013