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POLICE: APPLICATION

First Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Primary (mobile) Telephone
Secondary Telephone
E-mail
Age
Gender
Citizenship

Emergency Contact Name
Relationship
Contact telephone
Secondary contact telephone

Section Two: Student Credentials

Valid State Concealed Weapon Permit
	Provide a valid state Concealed Weapon Permit (CCW). Issuing state must require both a state and federal background check for approval. Issuing state and expiration date.

Active Duty Military/Reserves
	Any active duty member of the United State Army, Air Force, Marine Corps, Navy, Coast Guard, National Guard or Reserves. Branch, rank and end of obligated service.

Active Law Enforcement Officer
	Any active POST certified Police Officer, Federal Law Enforcement Officer, Government employee with a secret clearance or any honorably retired, after ten years service, state or federal police officer. Department, position and length of service.

Criminal Record History Check
	Provide a current copy of a Criminal Record History Check from your state of residence within twelve (12) months of training course date showing no criminal activity.

Section Three: Previous Training

Please detail any previous firearms training you've received:


Firearm information:
	Manufacturer:
	Model:
	Caliber:
	Strong hand:

Section Five: Statement of Eligibility

I hereby certify by my digital signature that I have no criminal convictions that prevent me from legally possessing, owning or purchasing firearms. I further certify that I have no official or unofficial history of mental illness or substance abuse and I further certify I have never been affiliated with or belong to any gang or other illegal organization involved or engaged in any illegal activities. This includes international or domestic terriorist organizations. I authorize agents of Common Task Tactical Training, Inc. to investigate the validity of my statement by any means necessary. Failure to comply will consititute non-compliance with company policy and removal from training course.

Common Task Tactical Training, Inc.'s operations depend upon the careful control of each students cooperation regarding safety issues, therefore, I understand that my instruction may be terminated at any time if my conduct is not deemed satisfactory at the sole discretion of the staff. That I will abide meticulously by any and all safety procedures required, and that I agree to sign a statement releasing Common Task Tactical Training, Inc. from any injury I may sustain during the program.

To finalize the application, you must enter your Full Name, select the date, and type "AGREE" in the Agreement box below:
Full Name: Date:
Agreement: