Form 4 - Application For Renewal Of Certification - Colorado Department Of Law

Download a blank fillable Form 4 - Application For Renewal Of Certification - Colorado Department Of Law in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 4 - Application For Renewal Of Certification - Colorado Department Of Law with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

FORM
Application For
Renewal of Basic
4
Certification
Colorado Department of Law
Criminal Justice Section, POST Board
January 2015
th
1300 Broadway 9
Floor
Denver, CO 80203
post@state.co.us
720-508-6721 FAX 866-858-7486
_____________________________________________________________________________________
Last Name
First
Full Middle
________________________________________________________________________________________________________
Home Address
City
State
Zip
________________________________________________________________________________________________________
Mailing Address (if different from above)
City
State
Zip
______________________________________________________________
Aliases
NOTE: All personal information
provided to POST is confidential and
Home phone: _______________________ Cell phone: ____________________
will not be released to the public,
Date of Birth: ______________________
Gender: M
F
pursuant to § 24-72-204, C.R.S.
Colorado Basic Certificate or PID# _________________
________________________________________________________________________________________________________
My most recent Colorado law enforcement employment:
1.
Agency ______________________________________ From: _______________To: ________________
I possess current first aid and CPR certification. (Attach copy of front and back of each card.)
2.
My fingerprints have been submitted on a POST fingerprint card to the Colorado Bureau of Investigation.
3.
(Fingerprints must be current within one year of certification.)
I have not been convicted of any felony or any misdemeanor referenced in § 24-31-305(1.5), C.R.S.
4.
I am not under investigation or pending investigation for any felony or any misdemeanor referenced in
5.
§ 24-31-305(1.5), C.R.S.
6.
I have
I have not served in the U.S. Military and have not been released or discharged under dishonorable
conditions. (Attach copy of DD-214 Showing Character of Service.)
7.
I am a United States citizen or legal resident who is lawfully present in the United States pursuant to
Federal Law and § 24-76.5-103, C.R.S.
8.
I possess a valid Colorado driver’s license or identification card or a United States military card . (Attach copy)
Under penalties of perjury, I declare that I have examined this affidavit and accompanying documents
and, to the best of my knowledge and belief, they are true, correct and complete. I further acknowledge
that any false statement, misstatement, or inaccuracy may result in revocation of my certification, as
well as criminal prosecution.
__________________________________________________________________
_____________________________________
Applicant's Signature
Date
Subscribed and sworn to before me this
day of
_______
___________________________ , _________.
My Commission Expires: _____--_____--________
_______________________________________________
NOTARY PUBLIC

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go