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Instructions: The applicant completes this form and forwards it to the agency head for his or her recommendation. The agency
head then forwards the completed form and all attachments to the POST Council. The Council notifies the agency head of the
action taken.
Full Name Agency Name
POST ID Number Rank/Title
Date of Birth Date Employed by Present Agency
Field of Employment
□ Peace Officer □ Public Safety Communication Officer □ ADULT Probation & Parole Officer
□ Corrections/Detention Officer □ Motor Carrier Services Officer □ JUVENILE Probation & Parole Officer
Certificate Applied for:
Date of Promotion (required for Supervisory, Command & Administrative)
□ Basic □ Basic Equivalency □ Intermediate □ Advanced □ Supervisory □ Command □ Administrative
Officer Experience Attach additional pages as necessary.
Agency Agency
Agency Location Agency Location
Dates of Employment Dates of Employment
Highest Rank Highest Rank
Officer Training Training must be supported by copies of POST transcripts.
College Education Education must be supported by copies of transcripts, diplomas or other verifying documents.
College and Location Dates Attended
Course of Study Hours Completed
Major Minor
□ Quarter
□ Semester
Degree Received
□ AA □ BA □ BS □ MA □ MS
Applicant Certification
I attest that the information contained on this application is true and correct to the best of my knowledge.
Signature of Applicant Date
Agency Recommendation
I recommend that the certificate be awarded. I certify that the applicant has complied with the minimum standards set forth in the
Administrative Rules of Montana, is of good moral character and is worthy of the award. My opinion is based on personal
knowledge of the inquiry, and the personnel records of this jurisdiction substantiate the recommendation.
Signature of Agency Head Date
POST Council Use Only
Approved for Approved by
Date Mailed
Revised 11/07
