Division of Criminal Justice
State of New Jersey
Police Training Commission
Notice of New Appointment
P.O. Box 085
Trenton, NJ 08625
for Law Enforcement and
Phone 609-984-0960
Corrections Officers
Fax 609-984-4473
Completion of this form is required whenever a law enforcement (or corrections) officer is appointed (hired)
Please type or legibly print (in ink) all required information
Mail or fax this notice to the PTC within 30 days of the appointment date
Identification Information
1. Social Security Number
2. Name
(Last)
(First)
(M)
suffix
3. Birth date
4. Gender
5. Maiden name or any previous name (Last)
(First)
(M)
Suffix
Male
Female
6. Race/Ethnicity (mark the box that best describes the applicant’s race/ethnicity
7. Education (Mark highest level completed)
American Indian or
Native Hawaiian or
HS
Bachelor’s
Master’s
Filipino
Grade 11
Alaskan Native
Other Pacific Islander
Diploma
Degree
Degree
Hispanic or
Grade 12,
Associate
Asian
White
Law
Latino
no diploma
Degree
Black or African
Some College -
Other
GED
Doctorate
American
credits completed:
Appointment Information
8. Employing Agency Name
9. County
10. Employing Agency ORI
11. Job Title Code
12. Date of Appointment (mm/dd/yyyy)
13. If Civil Service, date of test (mm/dd/yyyy)
N J
14. Attestation of reporting official
I attest that the information provided on this form is true and correct and is based on my personal knowledge or inquiry. The personnel records of this
agency substantiates the information on this form.
Signature of department head or authorized designee
Full name and title (type or print legibly)
Date
Phone
Job Title Codes
Arson Investigator
AINV
Investigator, Dept. of Corrections Internal Affairs
INVC
Auxiliary Police Officer
AUXP
Juvenile Corrections Officer
JCO
Campus Police Officer
CAMP
Juvenile Detention Officer
JDO
Chief Warrant Officer
CWO
Juvenile Parole Officer
JPO
Class 1 Special Law Enforcement Officer
SLE1
Juvenile Residential & Day Program Youth WorkerJRDP
Class 2 Special Law Enforcement Officer
SLE2
Municipal Police Officer
PO
Conrail Police Officer
RAIL
New Jersey State Police
NJSP
County Airport Security Officer
AIRP
NJ Transit Rail Police Officer
RAIL
County Corrections Officer
CCO
Other
OTHR
County Detective
CDET
Parole Officer
PARL
County Investigator
CINV
Security Officer in Housing Authorities
HOUS
County Park Police Officer
PO
Sheriff's Investigator
SHRI
County Park Ranger
CPR
Sheriff's Officer
SO
County Police Officer
PO
SPCA Officer
SPCA
Delaware River Port Authority Police
DRPA
State Conservation Officer
SCON
Department of Defense Police Officer
DEFE
State Corrections Officer
SCO
Dept. of Human Services Police Officer
HSER
State Investigator
SINV
Deputy Conservation Officer
DCO
State Park Ranger
SPR
Deputy Sheriff
DSHE
PTC 3-NONA Rev 6/15/04