MGENDER F
SS#
Date of Birth:
U.S. Citizen?
Yes No
Last Name:
Highest Educational level completed:
HS / GED
AA / AS BA / BS MA / MS PhD / JD
E mail
Registration Type:
Basic Academy
LEO BAT COR BAT PAA CSR
Work #:
Class
Expiration
Year only
ST
Investigator
First: M.I.
Place of Birth:
City & State
Lic #
Home Address:
Street Apt. City State Zip
POOL
NOT your cell.
Home #:
Cell #:
Include dashes as on your license
Test Date
Job Link
Class #
NoYes
Ethnicity
Conditional Offer
Station:
Newspaper Ad.
Who?
Job Fair or Recruiting Event
All applicants are requested to complete the following survey prior to submitting their registration.
Please indicate below how you heard about the Brevard Police Testing Center. Check any and all that apply.
Internet Ad/Job listing.
BCC Staff Member, Counselor, Advisor, Instructor
Former Academy Student.
Brevard Police Testing Center Website.
Other Source, Radio? TV?
NOT your cell.
Registered with Selective Service?
Which?
This is my
BPTC UNIVERSAL REGISTRATION
Provide ALL requested information. Failure to due so may result in Candidate Disqualification
Equal Employment Opportunity
Consistent with applicable laws and regulations, employment practices and management decisions of the Brevard Police Testing Center are based solely
upon the qualifications and merit of applicants for employment. There shall be no discrimination against any applicant because of race, color, sex, religion,
national origin, or disability.
Today's Date:
Law Enforcement Officer
Name / Agency
