National Park Service
Seasonal Law Enforcement Training Program
APPLICATION PACKET
FALL 2012
August 26 – November 09
Application Instructions
Applications for the fall 2012 program are now being accepted. Final acceptance is based on a completed application with all forms on a first come first serve basis.
All students must submit a $1000.00 deposit with their application materials. This deposit is refundable up until July 2, 2012 should you not be able to attend the program. Make the check or money order payable to Unity College.
UNITY COLLEGE
90 QUAKER HILL ROAD
UNITY, MAINE 04988
Seasonal Law Enforcement Training Program
APPLICATION
Complete this formhonestly andthoroughly and return to Unity College FAILURE TO CORRECTLY COMPLETE AND RETURN ALL APPLICATION MATERIALS MAY ELIMINATE YOU FROM CONSIDERATION FOR ENTRY INTO THE PROGRAM. A FAILURE TO FULLY AND TRUTHFULLY DISCLOSE INFORMATION MAY ALSO BE GROUNDS FOR NON-ACCEPTANCE TO THE PROGRAM.
COMPLETE NAME: ______NICKNAME:______
ADDRESS:______APARTMENT NO.:______
CITY: ______STATE: ______ZIP CODE: ______
TELEPHONE: (HOME) ______(MESSAGE) ______
OTHER CONTACT: (E-MAIL) ______(FAX)______
UNITED STATE CITIZEN: □YES□ NO
SOCIAL SECURITY NO.: ______DATE OF BIRTH: ______
HEIGHT: ______WEIGHT: ______WAIST SIZE: ______
PLEASE CHECK ONE: RIGHT-HANDED ______LEFT-HANDED ______
I AM APPLYING FOR: (Please check one) □ CREDIT (16 undergraduate credits awarded by Unity College)
□ NON-CREDIT
Room and Board Options: (Choose one)
□Room with 5day meal plan□ Room only (no meals)□Meals only (5day meal plan, Monday-Friday)
Student rooms are actually 4 bedroom apartments. All students will have a private room in one of the apartments. The apartments are fully equipped for cooking should you choose the room only option, including stove, refrigerator, coffee pot, toaster, utensils, place settings for 4, and pots and pans for cooking.
DRIVER’S LICENSE NO.:______STATE: ______EXPIRATION DATE:______
(ATTACH COPY OF YOUR DRIVER’S LICENSE(S) TO THIS APPLICATION)
VEHICLE INFORMATION: YEAR______MAKE: ______MODEL: ______
LICENSE PLATE #: ______STATE: ______EXPIRATION DATE:______
AUTO INSURANCE COMPANY: ______EXPIRATION DATE:______
I. Please complete the following questions to the best of your knowledge.
(use back of page if needed, or attach additional pages)
- DESCRIBE YOUR EDUCATION (INCLUDE DEGREE(S) EARNED, MAJOR, TOTAL QUARTER/SEMESTER CREDITS):
- EXPLAIN YOUR COMPLETE WORK HISTORY FOR THE PAST FIVE (5) YEARS** (TYPE OF WORK OR POSITION AND LENGTH
OF TIME EMPLOYED, REASON(S) FOR LEAVING):
I have □ have not □ registered for the Selective Service System (military draft). Note: A failure to register for the
Military draft may adversely affect your hiring potential into Federal Law Enforcement employment.
a. ANY MILITARY / LAW ENFORCEMENT / CRIMINAL JUSTICE EXPERIENCE:
- EXPLAIN ANY FIREARMS TRAINING AND EXPERIENCE (CERTIFICATES EARNED, ETC.)
- EXPLAIN YOUR DRIVING EXPERIENCE AND/OR TRAINING:
- HOW MANY YEARS OF DRIVING EXPERIENCE DO YOU HAVE? ______
- EXPLAIN ANY MARTIAL ARTS, DEFENSIVE TACTICS, OR OTHER COMPARABLE TRAINING YOU HAVE HAD?
- DO YOU POSSESS ANY BELTS, CERTIFICATES, ETC.? YES NO TYPE:______
h. DESCRIBE YOUR PRESENT PHYSICAL CONDITION. HOW YOU PLAN ON PREPARING YOURSELF TO MEET THE
RIGOROUS STANDARDS REQUIRED FOR CERTIFICATION FROM THIS PROGRAM?
- DESCRIBE ANY EMPLOYMENT AND/OR EXPERIENCES YOU HAVE ENCOUNTERED LEADING TO YOUR BECOMING
FAMILIAR WITH ANY PARK SYSTEM.
II. Personal Insurance Information:
In order to attend the SLETP, medical insurance is required to cover any injury or accident that may occur during
training.
Do you presently have personal injury insurance? Yes-______No -______
If yes, what is the name of your insurance carrier? ______
Policy Number: ______Agent: ______Expiration Date:______
If no, it is necessary for you to access a plan suitable to your individual needs. An applicant cannot be considered
for placement into SLETP if medical insurance is not obtained.
*ACCEPTANCE FOR ENROLLMENT REQUIRES VERIFICATION OF INSURANCE*
III. Miscellaneous Information:
- Are you aware that the sole purpose of this training program is to train you how to perform as a law enforcement park ranger, protection officer or reserve officer? Yes______No ______
- If, in the performance of your assigned duties, could you take the life of another if the situation necessitated
such an escalation of force? Yes______No______
- Have you ever used or experimented with drugs? Yes______No______
Type(s) of drugs ______Date last used: ______
- Have you ever been diagnosed with or experienced a mental or personality disorder, including but not limited to schizophrenia, psychoses, manic depression, or have attempted to take your own life? Yes____ No_____
- Have you ever been convicted of a felony? Yes______No______
Date(s)______Type:______
- Have you ever been convicted of a misdemeanor crime of domestic violence? (The conviction must be for
misdemeanor-graded offense and have, as an element, the use or attempted use of physical force, or the
threatened use of a deadly weapon, committed by a current or former spouse, parent, or guardian of the
victim, by a person with whom the victim shares a child in common, by a person who is cohabiting with or has
cohabited with the victim as a spouse, parent, or guardian, or by a person similarly situated to a spouse,
parent, or guardian of the victim).Yes ______No ______Date(s) ______
- Are you subject to an active Protection from Abuse Order, which provides for the confiscation of firearms during the period of time the order is in effect? Yes ______No ______
h. Under federal law you may be disqualified to receive or possess a firearm if you meet any of the following conditions:
(a) Currently under Indictment or Information in any court for a crime punishable by imprisonment for a term exceeding on year.
(b) Have been convicted in any court of a crime punishable by imprisonment for a term exceeding one year. A person would not be ineligible under this criteria if the person has been pardoned for the crime or conviction, the crime or convictions has been expunged or set aside, or the person has had his/her civil rights restore, and under law where the conviction occurred the person is not prohibited from receiving or possessing any firearm.
(c) Are a fugitive from justice
(d) Are an unlawful user of, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other controlled substance.
(e) Have been adjudicate mentally defective or have been involuntarily committed to a mental institution
(f) Have been discharged from the Armed Forces under dishonorable conditions.
(g) Are illegally in the United States
(h) Have renounced his/her citizenship, having previously been a citizen of the United States.
NOTE: A “crime punishable by imprisonment for a term exceeding one year” as discussed in (a) and (b) above is defined in federal law so as to exclude most misdemeanors in Maine.
Based upon the above information are you disqualified to receive or possess firearms under any of the above provisions of federal law? Yes ______No ______
i. Is your driver’s license currently under suspension, restriction, revocation or awaiting reinstatement?
Yes______No______Restrictions:______
j. Do you have current First Aid and/or CPR Certification? Yes______No______Expiration date:______
Type:______Issued By:______
k. Do you have current First Responder or EMT Certification? Yes_____No______Expiration date:______
l. Other than those noted above, list any other certifications you possess:
Type:______Expiration Date:______
Type:______Expiration Date:______
m. Do you desire to seek employment within a specific park or law enforcement agency upon completion of this
Program? Yes_____ No______
n. If known, please list your choice(s) of preferred parks and/or agencies below:
Park/Agency______
Location______
Park/Agency______
Location______
Park/Agency______
Location______
______
Applicant Signature Date
Print and mail this completed application to:Unity College
Registrar’s Office
90 Quaker Hill Road
Unity, Maine 04988
Unity College SLETP