Student Application
Contact Information
Fill out each field. If you have any questions, please ask an administrator
Full Name
*
First Name
Full Middle Name (NO INITIALS)
Last Name
Suffix
Phone Number
*
Please enter a valid phone number.
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Previous Address #1
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
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Emergency Contact
Emergency Contact's Name
*
First Name
Last Name
Relationship to Emergency Contact
Parent/Guardian
Spouse/Partner
Immediate Family Member
Other
Emergency Contact's Phone Number
*
Please enter a valid phone number.
Emergency Contact's Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Personal Information
Fill out each field. If you have any questions, please ask an administrator
Date of Birth
*
-
Month
-
Day
Year
Date
Sex assigned at birth:
*
Please Select
Male
Female
Place of Birth (City, State)
*
Country of Citizenship
*
Have you ever renounced your citizenship?
*
Yes
No
Social Security # (nine numbers with no dashes)
*
If you do not have a social security number, please enter 000000000
Race
*
White/Caucasian
Black/African American
Asian
Native Hawaiian/Pacific Islander
American Indian/Alaskan Native
Other
Eye Color
*
Brown
Green
Blue
Hazel
Heterochromia
Other
Hair Color
*
Brown
Black
Blonde
Red
Gray
White
Other
Height (ft,in)
*
Approx. Weight (lbs.)
*
Do you speak any foreign language? (Please include language, fluency and reading/writing skill
*
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Driving History
Driver's License State
*
Please Select
None
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucy
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Driver's License No.
*
If you do not have a Driver's License, please enter 000000000
Are there any restrictions on your license? (If yes, explain. If no, please type No.)
*
Have you received a citation for a driving offense within the last seven years? (If yes, explain. If no, please type No.)
*
Have you ever paid a fine over $499.00? (If yes, explain. If no, please type No.)
*
Do you hold any out of state driver's license other than the one you provided above? (If yes, please enter the information for that license. If no, please type No.)
*
Do you have your own transportation?
*
Yes
No
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Work History
Starting with your current employer, please list your employment for the past five years.
Employer Name #1
*
Supervisor Name
*
Job Title
*
Responsibilities:
*
Dates Difference (If this is your current job, enter today's date in the end date field)
*
Reason for leaving
*
Employer Name #2
*
Supervisor Name
*
Job Title
*
Responsibilities:
*
Dates Difference
Reason for leaving
Employer Name #3
Supervisor Name
Job Title
Responsibilities:
Dates Difference
Reason for leaving
Have you ever had a professional license or certification revoked, suspended or modified for any reason? (If yes, explain. If no, please type No.)
*
Have you ever been reprimanded, placed on probation or otherwise disciplined by a professional licensing or certification body? (If yes, explain. If no, please type No.)
*
Have you ever been disciplined or cited for a breach of ethics or unprofessional conduct? (If yes, explain. If no, please type No.)
*
Have you ever resigned or been discharged from any position with criminal or administrative charges pending against you? (If yes, explain. If no, please type No.)
*
Have you ever been prohibited from doing business with the State of Georgia, the United States Government or any local/state government? (If yes, explain. If no, please type No.)
*
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Medical History
Have you ever been diagnosed with a mental health condition, or have you ever been committed to a mental institution? (If yes, explain. If no, please type No.)
*
Do you have any medical/physical limitations that may impair your abilities to safely perform the required training tasks to become a Security Officer? (If yes, explain. If no, please type No.)
*
Are you an unlawful user of, or addicted to, marijuana or any depressant, stimulant or narcotic drug or controlled substance? (If yes, explain. If no, please type No.)
*
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Military Background
Have you ever served in the military?
*
Yes
No
What Branch?
*
If you have not served, please enter N/A
Rank at Discharge
*
If you have not served, please enter N/A
Date Range
Type of Discharge
*
Please Select
I did not serve
Honorable
General
Other Than Honorable
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Background History
Answer these questions honestly and with as much detail as you can. Failure to disclose the information can lead to a fine up to $500 or a warrant of arrest from the Georgia State Attorney General.
Have you ever been arrested? (If yes, please type the date and details of your arrest. If no, please type No.)
*
Tip: If at some point a police officer placed you in handcuffs and/or in custody, you were arrested.
Have you ever been known by another name? (If yes, please type each name. If no, please type No.)
*
Have you ever worked as a peace officer? (If yes, please type where. If no, please type No.)
*
Are there currently any charges pending against you for a criminal offense? (If yes, please type what charges and where. If no, please type No.)
*
Are you under indictment for information in any court for a felony or any other crime, for which you may be imprisoned for more than one year, even if you received a shorter sentence or probation? (If yes, explain. If no, please type No.)
*
Have you been convicted of a felony, in any court, of a misdemeanor crime of domestic violence? (If yes, explain. If no, please type No.)
*
Have you ever entered a plea pursuant to the provision of "GA First Offender Act" or any other first offender act? (If yes, explain. If no, please type No.)
*
Are you subject to a court order restraining you from harassing, stalking, or threatening a child, intimate partner, or child of an intimate partner? (If yes, explain. If no, please type No.)
*
Are you a fugitive from justice? (If yes, explain. If no, please type No.)
*
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Licensing and Permits
Please select the type of licensing/permits you currently have
*
Guard Card
Weapons Permit
CPR Card
First Aid
O.C Spray Certification
Baton Certification
None
Other
Please enter the license/permit number for each certification you selected above. If permitted to carry a weapon, please enter the make, model/caliber and serial number
*
If you do not have any certification, please enter N/A
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Who referred you to LAWES Academy?
*
Chief Seegars
Sgt. Thompson
Stazia Kingcannon
Kay Thomas
No one
Other
I have answered the above questions truthfully to the best of my ability. I understand that failure to disclose the correct information will result in the immediate rejection of my application.
*
Are you here as a Private Student or with a Company?
*
Please Select
Private Student
Company
Upon completion of your course work, how would you like to receive your certification(s)? NOTE: This question is only for private students. If a company is paying for your tuition, DO NOT answer this question.
Please mail my certification(s) to the address provided on this application
I will pick up my certification(s) when it/they are ready
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