"Law Enforcement Agency Credential Sheet" - New Mexico

Law Enforcement Agency Credential Sheet is a legal document that was released by the New Mexico Department of Public Safety - a government authority operating within New Mexico.

Form Details:

  • Released on July 1, 2012;
  • The latest edition currently provided by the New Mexico Department of Public Safety;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the New Mexico Department of Public Safety.

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LAW ENFORCEMENT AGENCY CREDENTIAL SHEET
1. LEA USER APPLICATION/CREDENTIAL FORM (NON-DPS EMPLOYEES)
NEW
TRANSFER
Yes
No
REVOKE
MODIFY
DELETE
Sworn Officer (arresting power)
First
Middle Initial
Name: Last
Phone #:
Fax #:
Title:
E-mail:
2. EMPLOYING ORGANIZATION
ORI #:
Municipal
County
State
Tribal
Federal
:
Department and/or Agency
Bureau/Division/Unit
3. OFFICE CONTACT INFORMATION
Street Address or P.O. Box
State:
Zip Code
City
4. ACCOUNT ACCESS REQUEST
UCR User
:
UCR View
LEA
NIBRS
CJIS
Date:
List CJIS Trainer:
List 28 CFR Trainer:
Date:
(ALL require 28 CFR & CJIS Training)
Motor Vehicle Division
MVD
Other:
Seizure & Forfeitures Application - SF_USER role
Virtual Private Network
VPN
* Driver's License #:
5. CERTIFICATION
(
)
PLEASE COMPLETE SIGNATURE LINE
I hereby certify that I am an employee of the duly constituted Law Enforcement / Criminal Justice / Public Safety Agency described above in this application and that I understand and
consent to the terms of this application, including the provision set out in the CJIS Security Policy, V.4.4, and agree to abide by all such provisions.
Applicant Signature:
Month
Day
Year
6. APPLICANT SUPERVISOR
(
)
PLEASE COMPLETE SIGNATURE LINE
Name:
Title:
Email:
Fax:
Business Phone:
I herby confirm that the above named individual is an employee of a duly constituted agency described above and is authorized to have access to the DPS Information Systems
and Criminal Justice Information Systems. I certify that all policies outlined in the CJIS Security Policy, V.4.4, under section 4.5.1 Personnel Background Screening for Systems
Access and Computer Terminal/Records Storage Areas Access have been complied with.
Month
Day
Year
Supervisor Signature:
8. APPROVAL SIGNATURE:
7. SUBMIT APPLICATION
Law Enforcement Records Bureau
Mailing Address:
ATTN: CJIS Security Officer (CSO)
PO Box 162
CJIS Security Officer
Date
(CSO)
Santa Fe, NM 87504-1628
Scan & E-mail: Regina.Chacon@state.nm.us
505-827-9105
Fax:
Date Completed
Username Assigned
ITD Received:
Date Completed
Notification Date
Technician
Created By
Credential Form: (PDF v5.4/ 07.12)
*Required
LAW ENFORCEMENT AGENCY CREDENTIAL SHEET
1. LEA USER APPLICATION/CREDENTIAL FORM (NON-DPS EMPLOYEES)
NEW
TRANSFER
Yes
No
REVOKE
MODIFY
DELETE
Sworn Officer (arresting power)
First
Middle Initial
Name: Last
Phone #:
Fax #:
Title:
E-mail:
2. EMPLOYING ORGANIZATION
ORI #:
Municipal
County
State
Tribal
Federal
:
Department and/or Agency
Bureau/Division/Unit
3. OFFICE CONTACT INFORMATION
Street Address or P.O. Box
State:
Zip Code
City
4. ACCOUNT ACCESS REQUEST
UCR User
:
UCR View
LEA
NIBRS
CJIS
Date:
List CJIS Trainer:
List 28 CFR Trainer:
Date:
(ALL require 28 CFR & CJIS Training)
Motor Vehicle Division
MVD
Other:
Seizure & Forfeitures Application - SF_USER role
Virtual Private Network
VPN
* Driver's License #:
5. CERTIFICATION
(
)
PLEASE COMPLETE SIGNATURE LINE
I hereby certify that I am an employee of the duly constituted Law Enforcement / Criminal Justice / Public Safety Agency described above in this application and that I understand and
consent to the terms of this application, including the provision set out in the CJIS Security Policy, V.4.4, and agree to abide by all such provisions.
Applicant Signature:
Month
Day
Year
6. APPLICANT SUPERVISOR
(
)
PLEASE COMPLETE SIGNATURE LINE
Name:
Title:
Email:
Fax:
Business Phone:
I herby confirm that the above named individual is an employee of a duly constituted agency described above and is authorized to have access to the DPS Information Systems
and Criminal Justice Information Systems. I certify that all policies outlined in the CJIS Security Policy, V.4.4, under section 4.5.1 Personnel Background Screening for Systems
Access and Computer Terminal/Records Storage Areas Access have been complied with.
Month
Day
Year
Supervisor Signature:
8. APPROVAL SIGNATURE:
7. SUBMIT APPLICATION
Law Enforcement Records Bureau
Mailing Address:
ATTN: CJIS Security Officer (CSO)
PO Box 162
CJIS Security Officer
Date
(CSO)
Santa Fe, NM 87504-1628
Scan & E-mail: Regina.Chacon@state.nm.us
505-827-9105
Fax:
Date Completed
Username Assigned
ITD Received:
Date Completed
Notification Date
Technician
Created By
Credential Form: (PDF v5.4/ 07.12)
*Required