Fillable Form Lea-Satapp - Regional / Satellite Academy Application printable pdf download

New Mexico Department of Public Safety Training Center

4491 Cerrillos Road, Santa Fe, New Mexico 87507

(505) 827-9251―(877) 237-7532 (NM Only) ―Fax: (505) 827-3449―

REGIONAL / SATELLITE ACADEMY APPLICATION

The following forms and supporting documents must be submitted to a New Mexico Regional / Satellite

Academy for enrollment in a Basic Academy program.

ITEMS REQUIRED

ITEMS REQUIRED BY ALL APPLICANTS

PPLICANTS

Form No. LEA-1 –

Application for Admission/Certification.

Form No. LEA-2 –

Employment Verification. Form must have original signatures.

Form No. LEA-3 –

Medical Examination

Procedures, Medical History Statement and Medical Selection

Guidelines. Examination must be dated within one year prior to admission to applicable program. Must have

original signatures. (pages 1-17).

Form No. LEA-4 –

Current Psychological Examination.

Form must have original signatures. Examination

must include psychologist’s narrative and be dated within one year prior to admission to applicable programs.

Form No. LEA-5 –

Fingerprint Affidavit. Form must have original signatures.

Form No. LEA-6 –

Applicant Affidavit. Form must have original signatures.

Form No. LEA-8 –

Waiver of Liability. Form must have original signatures.

Form No. LEA-9 –

Release of Information. Form must have original signatures.

copy of high school diploma, G.E.D. certificate or college diploma

Notarized

Form No. LEA-12 –

Applicant Affidavit of United States Citizenship or proof of U.S. citizenship issued by

an official government agency.

Form No. LEA-14 –

Physical Fitness Verification. Form must have original signatures

- Training Certification for FIRST AID & CPR

Form No. LEA-15

- Applicant Affidavit of proof of possession of a current valid driver’s license.

Form No. LEA-16

- Agency Employment Action.

Form must have been previously submitted by employing

Form No. LEA-82

agency or attached to this application. Check

N/A

for self-sponsored applicant not currently employed by a LEA.

copy of DD214 form (if applicant has had military service) Form must indicate character of service.

Notarized

REGIONAL / SATELLITE ACADEMY VERIFICATION OF RECORDS

I_________________________________ certify that ____________________________ has met all requirements to

Academy Director (print name)

Applicant (print name)

attend ______________________________________ Class________ from _______________ to ______________

Regional / Satellite Academy

Number

Date

in accordance with the Law Enforcement Training Act 29-7-6 NMSA 1978 and Qualifications for Admission to the

Academy 10.29.1.10 NMAC. I certify that all required admission forms listed above including supporting

documentation, where applicable, are on file at the Regional / Satellite Academy business office and are available

for review by the Director of the NM Law Enforcement Academy or his designee.

Signature: ________________________________________ Date:_____________________

State of New Mexico

}

County of ____________________________ }SS

On this ______ day of ________________, 20___, before me personally appeared __________________________

Academy Director (print name)

known to me to be the person whose name is subscribed to the above

instrument and acknowledged the same to be his/her own free act and deed.

Notary Public:______________________________________ My commission expires:_______________________

(SEAL)

Mail or deliver original LEA-SATAPP,

LEA-1, LEA-3

(Page 19 only),

LEA-4

(Form only, do not include

psychologist’s narrative) and

LEA-82

(if applicable) to:

New Mexico Department of Public Safety

Training and Recruiting Division

4491 Cerrillos Road, Santa Fe, NM 87507

Revised 07-03-13

LEA-SATAPP

Form Lea-Satapp - Regional / Satellite Academy Application

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