Lone Star College System

LONE STAR COLLEGE SYSTEM

LAW ENFORCEMENT ACADEMY

APPLICATION

The Texas Commission on Law Enforcement Officers Standards and Education (TCLEOSE) requires that all applicants for academy classes must have been fingerprinted and subjected to a search of records and fingerprint files to disclose any criminal record. The following information is necessary in order for a complete and proper background check to be performed. Please complete ALL of the following information. Incomplete or incorrect information will be grounds for disqualification from the academy application process.

NAME: ______

LASTFIRSTMIDDLE

ALL PREVIOUS NAMES: ______NICKNAME: ______

SEX: ______RACE: ______DATE OF BIRTH: ______AGE: ______

PLACE OF BIRTH: ______ARE YOU A UNITED STATES CITIZEN: YES NO .

DRIVER’S LICENSE NUMBER: ______STATE: _____ EXP. DATE: ______

YOU MUST HAVE A VALID TEXAS DRIVER’S LICENSE

SOCIAL SECURITY NUMBER: ______

CURRENT ADDRESS: ______

STREET ADDRESS

______

CITY STATE ZIP CODE

PREVIOUS ADDRESS: ______

(COMPLETE THIS IF YOU HAVE BEEN AT YOUR CURRENT ADDRESS LESS THAN 5 YEARS)

HOME PHONE: ______WORK PHONE: ______

CELL ______

EMAIL: ______

PLEASE NOTE:

PLEASE READ THE REQUIREMENTS CAREFULLY TO INSURE YOU ARE ELIGIBLE AND MEET THE CRITERIA.

PROOF OF EDUCATIONAL REQUIREMENTS MUST BE SUBMITTED WITH YOUR APPLICATION. RESUME, ESSAY, AND COLOR PICTURE OF YOURSELF NEEDS TO BE INCLUDED. NO INCOMPLETE PACKETS WILL BE ACCEPTED.

EDUCATIONAL REQUIREMENTS: YOU MUST SUBMIT ONE OF THE FOLLOWING:

1. A high school diploma from a high school accredited by a state department of education and/or a recognized regional accrediting association– Enclose a copy of the diploma or transcript. (High school diploma is a document issued by a school district or a school accredited by the Texas PrivateSchool Accreditation Commission verifying that the recipient has successfully completed the course of study prescribed by the school district and accepted by the Texas Education Agency).

2. Written proof of a GED (General Education Development) as certified by a state agency.

*(Verification of GED Certification in Texas can be obtained by calling TEA at 512-463-9292).

* The academy may require additional official transcripts or additional documentation to verify high school graduation, GED certification or college hours. (A college is defined as: An institution of higher education that is accredited or authorized by the Southern Association of Colleges and Schools, the Middle States Association of Colleges and Schools, the New England Association of Schools and Colleges, the North Central Association of Colleges and Schools, The Northwest Commission on Colleges and Universities, or the Western Association of Schools and Colleges.

** For those students without any college credit, you must pass a compass test before entering theacademy. The testing ticket is available at the academy.

3. An honorable discharge from the armed forces of the United States after at least 24 months of active duty service – Enclose a copy of your DD214.

Do not leave this section blank

HIGH SCHOOL ATTENDED: ______

CITY, STATE ______DATE OF GRADUATION: ______

GED CERTIFICATE NUMBER: ______DATE COMPLETED: ______

COLLEGE: ______DATES ATTENDED: ______

DEGREE: ______CERTIFICATION: ______

LONE STAR COLLEGE SYSTEM

LAWENFORCEMENTACADEMY

20515 SH 249, BUILDING 12, SUITE 117

HOUSTON, TEXAS 77070 281-290-5030

APPLICATION FORM 3/7/2013

CRIMINAL HISTORY STATEMENT

*HAVE YOU EVER BEEN ON COURT-ORDERED COMMUNITY SUPERVISION OR PROBATION FOR

ANY CRIMINAL OFFENSE ABOVE THE GRADE OF A CLASS B MISDEMEANOR OR A CLASS B

MISDEMEANOR IN THE LAST 10 YEARS FROM THE DATE OF THE COURT ORDER?

YES_____ NO_____

*HAVE YOU EVER BEEN CONVICTED OF A FELONY? YES_____ NO_____

*HAVE YOU EVER BEEN CONVICTED OF AN OFFENSE ABOVE THE GRADE OF A CLASS B

MISDEMEANOR OR A CLASS B MISDEMEANOR IN THE LAST 10 YEARS? YES_____ NO_____

*ARE YOU CURRENTLY ON PROBATION OR COURT-ORDERED COMMUNITY SUPERVISION

SUBSEQUENT TO BEING CHARGED WITH A FELONY? YES_____ NO_____

*HAVE YOU EVER BEEN CONVICTED OF THE OFFENSE OF BARRATRY? YES_____ NO_____

*ARE YOU PROHIBITED BY STATE OR FEDERAL LAW FROM OPERATING A MOTOR VEHICLE?

YES_____ NO_____

*ARE YOU PROHIBITED BY STATE OR FEDERAL LAW FROM POSSESSING FIREARMS OR

AMMUNITION? YES_____ NO_____

*HAVE YOU BEEN CONVICTED OF ANY CRIME OF DOMESTIC VIOLENCE? YES___ NO___

*ARE YOU CURRENTLY UNDER INDICTMENT FOR ANY CRIMINAL OFFENSE? YES_____ NO_____

*HAVE YOU EVER HAD A TCLEOSE LICENSE DENIED OR REVOKED? YES_____ NO_____

(Answering yes to any question with an asterisk (*) makes you ineligible to attend a Law Enforcement

Academy in the state of Texas. )

I hereby certify that the above information to the best of my knowledge is true, accurate and complete. I also acknowledge that any falsification of, or material omission in this record will be cause for cancellation of this application for the Law Enforcement Academy and cause for dismissal from the Academy at any later date if the information is found to be incorrect or untruthful.

I do also hereby authorize the Lone Star College SystemLaw Enforcement Academy to make a criminal history search, background investigation, and fingerprint check of any and all files necessary to verify any required admission criteria, and do hereby release, absolve, and forever hold harmless the Lone Star College System, and any college employees or administrators or their agents from any liability arising from this investigation.

NAME (PRINT) ______

SIGNATURE ______DATE ______

FOR ACADEMY USE ONLY

APPLICATION REVIEWED BY: ______DATE: ______

FOR OFFICE USE ONLY

Date application received ______

Test Scores: Reading____ Writing____ Math____ Pass ______

Date FAST results received ______

Birth certificate received ______

Date L – 2 given ______received ______

Date L – 3 given______received ______

Under 30 – Date meningitis vaccination received AGE:______

Date the authorization to register was issued ______

NOTE: It is the applicant’s responsibility to verify the status of his/her application. Once accepted, the applicant must register for the class and registration is on a “first come, first served” basis. Maximum enrollment is 40 per class.

COMMENTS:

LoneStarCollege System is committed to the principle of equal opportunity in education and employment. The college does not discriminate against individuals on the basis of race, color, gender, religion, disability, age veteran status, nationality or ethnicity in the administration of its educational policies, admissions policies employment policies, scholarship and loan programs, and other college-administered programs and activities.

Lone Star College System