PDF Form

Law Enforcement & Security Private Training Academy Application Process
How did you hear about how Law Enforcement and Security Academy? *
Name*

First NameLast Name
Date of Birth*

MonthDayYear
SSN*
Re-enter SSN*
Driver's License Number*
Driver's License State*
Driver's License Expiration *

MonthDayYear
We use the address on your driver’s license to mail class materials. If your driver's license does not match your current address and materials are lost in the mail, you will be required to repurchase class materials:

Basic Security class materials repurchase $150

Private Investigation class materials repurchase $200
My Driver's License Matches my current address*

YesNo, I am ok with paying the cost of lost class materials
Address*

Street Address

Street Address Line 2

CityState

Zip Code
How long have you lived at your current residence?*
Ethnicity*
Email*
example@example.com
Are you certified to work in the US?*

YesNo
Phone Number*

Phone Number
Other Countries of Citizenship
Sex*

MaleFemale
Eye Color*
Hair Color*
Height*
Personal Information

Honesty is always the best policy. We would rather know the truth now than be surprised later when we conduct a background check… because we will find everything. If we do find criminal information not revealed, the applicant will be rejected.
Have you ever been known by another name? If so, list name(s)?*
Are you a user of, or addicted to marijuana or any depressant, stimulant, or narcotic drug, or any other controlled substance? If yes, please explain:*
Do you have any medical/autoimmune/physical limitations that may impair your abilities to safely perform the required training tasks to become a Security Officer? If yes, please explain:*
Have you ever renounced your United States citizenship? If yes, please explain:*
Are you an alien Illegally in the United States? If yes, please explain:*
Do you speak any foreign language? If yes, which language(s) and fluency of each: *
Driving History
Are there any restrictions on your license? *
Have you received a citation in the last 7 years? If yes, please explain:
Have you ever paid a fine over $499? If yes, please explain:
Do you hold any out-of-state driver's license? If yes, list state:
Do you own your own transportation?*

YesNo
If you own a weapon and have a current Georgia Carry Permit, Please list weapon(s) you will use for range testing and on patrol

	Make	Model	Serial #	Gauge
Weapon 1
Weapon 2
Weapon 3
Weapon 4

Education
High School *
Start

MonthDayYear
End

MonthDayYear
College / University/ Trade school and years attended:
Start

MonthDayYear
End

MonthDayYear
College / University/ Trade school and years attended:
Start

MonthDayYear
End

MonthDayYear
College / University/ Trade school and years attended:
Start

MonthDayYear
End

MonthDayYear
College / University/ Trade school and years attended:
Start

MonthDayYear
End

MonthDayYear
College / University/ Trade school and years attended:
Start

MonthDayYear
End

MonthDayYear
Work Background
Are you a Veteran? if yes, complete the following:
Branch
Rank
Start

MonthDayYear
End

MonthDayYear
Total Length of Service
Type of Discharge
Have you ever worked as a Peace Officer? If so, where?
Have you, or any company in which you worked, ever been the subject of an investigation or litigation that was conducted by a federal, state or local agency? If yes, please explain:
Have you ever been reprimanded, placed on probation, or otherwise disciplined by a professional licensing or certification body? (add line to fill in if yes) If yes, explain:
Have you ever been disciplined or cited for a breach of ethics or unprofessional conduct? If yes, explain:
Have you ever been prohibited from doing business with the State of Georgia, the United States Government or any local or state government? If yes, explain:
Have you ever been registered with a licensed company as a Private Detective or Security Guard employee in this state?

YesNo
Employment History
Cards, Licenses & Permits

Employment History

	Employer name	Job Title	Employer Phone	Started	Ended
1
2
3
4
5

	Number	Expiration
Guard Card
Weapons Permit
CPR
First Aid
O.C Cert
Baton Cert
Other

Criminal Background
Have you ever been arrested?*

YesNo
Are there currently any charges pending against you for a criminal offense? If yes, what are the charges and where? *
Are you under indictment or information in any court for a felony or any other crime, for which the Judge could have imprisoned you for more than one year? If yes, please explain:*
Have you been convicted of a felony or any other crime for which the judge could have imprisoned you for more than one year, even if you received a shorter sentence including probation? If yes, please explain:*
Have you ever been convicted in any court of a misdemeanor crime of domestic violence? if yes, please explain:*
Are you subject to a court order restraining you from harassing, stalking, or threatening your child or an intimate partner or child of such partner? If yes, please explain:*
Have you ever entered a plea pursuant to the provision of ‘GA First Offender Act' or any other first offender act? Respond ‘Yes’ if you pled and completed probation as a First Offender.*

YesNo
Have you ever had a professional license or certification revoked, suspended, or modified for any reason? if yes, please explain:*
I Authorize the Law Enforcement & Security Private Training Academy to conduct a background investigation of me to determine my suitability for registration. I give my consent for full and complete disclosure of all records and information concerning myself to the Academy or authorized representatives whether such records and information are of a public, private or confidential nature, to include criminal history records.

YesNo
Clear
Should be Empty:

Law Enforcement & Security Private Training Academy Application Process

Personal Information

Driving History

If you own a weapon and have a current Georgia Carry Permit, Please list weapon(s) you will use for range testing and on patrol

Education

Work Background

Employment History

Cards, Licenses & Permits

Criminal Background