• ⚠️ IMPORTANT: Submitting this form does NOT enroll you in a class. You must complete the separate enrollment process to secure your spot. 

    🛑 Please do not fill out this form until you are enrolled into a class.   If you still need to enroll visit us at:  https://www.eventbrite.com/o/action-defense-10820047838

     

    📌Please have your Driver’s License or State ID handy to complete the required fields.

     

    📌 Requalifications: You must provide your current certificate —either upload it at the end of this form or bring a copy to class.

     

    🔍Please Review Carefully: Ensure all information is entered accurately and completely before submitting.

     

    👀Double-check SPELLING and DATES. Please use PROPER CAPITALIZATION OF NAMES.  ⚠️Even  minor errors or transposed digits will cause processing delays.

     

  • My class start date is: *
     / /
    2 digit month, 2 digit day, 4 digit year

  • Employing Agency

    Check the one the best applies to you:
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  • Student Enrollment/Certification Record

  • Student Information:

  • Please enter your COUNTY (not your State)

  • Format: 000 000 0000.
  • Gender*
  • DOB:*
     / /
    2 digit month, 2 digit day, 4 digit year

  • đź“ŚImportant Note: This email address will be used as the primary source of communication between you and OPOTC from the start of the academy through completion of the State Certification Exam (SCE). Please be sure to enter an email address that can be checked regularly for OPOTC correspondence.

  • đź“ŚFor your privacy we won't ask for your driver's license / State I.D. number online,   However you will be required to bring your  Identification to class to complete this form. 

  • Expiration Date of driver's License:/ State ID
     / /
    2 digit month, 2 digit day, 4 digit year
  • Race*
  • Education:*

  • Student Status:

  • Check One. This form is for my*
  • Check which weapon(s) you are qualifying with:*

  • ⚠️ IMPORTANT: Please review the following Disclosure Statements questions 1–24 carefully.

    If you answer YES to any question from 1–22, you cannot attend the class without prior clearance from OPOTA

    🛑 If you answer YES to any question 1–22, please stop and contact us. Email info@actiondefense.com or call 440-218-2029.

    Questions 23 and 24 may be answered YES and do not require prior OPOTA clearance.

  • Please answer the following questions by checking either "Yes" or "No" If you answer yes to questions 1-22, please provide a separate statement of explanation and supporting documentation.
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  • DISCLOSURES AND STATEMENT OF UNDERSTANDING

  • 1. Have you ever been convicted of a felony offense in any jurisdiction, including any conviction that has been sealed or expunged? (If so, you may not attend any portion of a Peace Officer Basic Training Academy.)*
  • 2. Are you a fugitive from justice?*
  • 3. Have you ever been convicted of a felony offense of violence as defined in ORC 2901.01?*
  • 4. Have you ever been adjudicated a delinquent child for the commission of an offense that, if committed by an adult, would have been a felony offense of violence?*
  • 5. Have you ever been convicted of any felony offense involving a drug of abuse?*
  • 6. Have you ever been adjudicated a delinquent child for the commission of an offense that, if committed by an adult, would have been a felony offense involving a drug of abuse?*
  • 7. Are you drug dependent, in danger of drug dependence, or a chronic alcoholic?*

  • The following 21 Questons If you have to answer YES to any question 1 through 21, you WILL NOT be able to attend the class without prior clearance from O.P.O.T.A

  • 8. Are you under adjudication from any court for mental incompetence?*
  • 9. Have you been adjudicated by a court as a mental defective?*
  • 10. Have you been committed by a court to a mental institution?*
  • 11. Have you been found by a court to be a mentally ill person subject to hospitalization by court order, or have you been an involuntary patient other than one who is a patient only for purposes of observation?*
  • 12. Have you even been convicted of a crime that had a possible sentence of more than one year?*
  • 13. Are you an alien, illegally or unlawfully in the United States?*
  • 14. Have you been discharged from the Armed Forces under dishonorable conditions?*
  • 15. Have you renounced your United States citizenship?*
  • 16. Are you under a court order that restrains you from harassing, stalking, or threatening an intimate partner or the child of such intimate partner, or engaging in other conduct that would place an intimate partner in reasonable fear of bodily injury to the partner or child?*
  • 17. Has any licensing or regulatory authority, in this or another state, ever denied you a license or government certification, or subjected you to discipline, including but not limited to suspension, revocation, or censure, because of professional misconduct or any other reason?*
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  • 18. Are you currently the subject of any complaints, allegations, investigations, or legal proceedings that relate to professional conduct, violations of laws regulating a profession, occupation, or occupational activity, or any alleged crimes, whether in this state or elsewhere? This includes matters pending before courts, administrative agencies, or other regulatory entities.*
  • 19. Have you previously been demoted, discharged, or resigned in connection with conduct involving (1) dishonesty; (2) alleged criminal misconduct; or (3) alleged violations of a citizen's civil rights?*
  • 20. Have you been convicted of a misdemeanor crime of domestic violence?*
  • 21. Have you been convicted of a misdemeanor crime that has, as an element of that crime, the use or attempted use of physical force, or the threatened use of a deadly weapon? If yes, please explain your relationship with the victim (stranger, present or former spouse, household member, child, other family member, other – please describe)*
  • 22. Do you currently have criminal charges pending in any jurisdiction?*

  • If you answer no to questions 23-24, please provide a separate statement of explanation and supporting documentation.

  • 23. Do you currently possess a valid driver's license and have driving privileges in the state of Ohio or any other state?*
  • 24. Have you been awarded, and do you possess a high school diploma or certificate of high school equivalency?*
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