LEMA Member Application

Application
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
E-mail *
Employing Agency and Agency's Address
Agency Phone Number

Area Code Phone Number
Are you currently POST licensed and employed as a full-time peace officer working for a public law enforcement agency in Minnesota?

Yes No
How many years have you been a peace officer? With your present agency? If you have worked for another police agency, in any position, other than your present employer, please list:
Do you have military experience?

Yes No
If yes, Branch, highest rank obtained, and specialization?
Have you served on an honor guard or drill team before?

Yes No
If yes, please give details including when, where, what type of duties, etc.
Please provide your height and weight
If selected to join the LEMA Honor Guard, are you able and willing to commit to a minimum of a three year membership?

Yes No
Does your department head support your membership in the Honor Guard, and would a command level officer be willing to write a letter to that effect?

Yes No
Do you have any additional employment or volunteer activities including extra-duty assignments?

Yes No
Can you play the bugle, trumpet, or coronet and would you be willing to serve as a bugler for the Honor Guard?

Yes No
If yes, please describe and list how many hours per week it involves:
Please list three persons, not related to you, who would be willing to provide a letter of reference on your behalf. These may include fellow officers, supervisors, or friends.

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I certify by my signature that the information supplied on this application, along with any additional materials submitted are true and correct to the best of my knowledge.

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