Basic Law Enforcement Training

Instructor Information Sheet

 

 

Name ______________________________________________________

 

Mailing Address: _____________________________________________

 

____________________________________________________________

 

Home Phone: ________________________________________________

 

Work Phone: _________________________________________________

 

Cell Phone: __________________________________________________

 

Pager: ______________________________________________________

 

Email Address: _______________________________________________

 

Emergency Contact Information:

 

Name: _______________________________ Relationship: ___________

 

Address: ___________________________________________________

 

Phone: _____________________________________________________

 

 

******************DO NOT WRITE BELOW THIS LINE *******************

 

Certifications:

 

            _________ General Instructor Certificate _______________________

                                                                                         Expiration Date

            _________ Specialized Certificates

           

                                    _____ Firearms

                       

                                    _____ SCAT

           

                                    _____ Physical Training

 

                                    _____ Driverís Training

 

                                    _____ CPR Certificate