Fill - Free fillable LETI Application Law Enforcement Training Institute Application (State University of New York College at Potsdam) PDF form

POLICE ACADEMY

SUNY POTSDAM

ACADEMY APPLICATION

REQUIREMENTS TO ENTER

 The following are the NEW YORK STATE requirements to apply to

the Academy

 Guidelines for all attendees including non-matriculated students

o Must be a U.S. Citizen OR legally residing within New York State

o Must be a High School Graduate or possesses a G.E.D.

o Cannot be a convicted felon

o Or arrested for Any Charge outside of New York that constitutes a Felony in New

York

 The following are SUNY Potsdam’s Added Requirements:

o Must be a Matriculated Student in their Junior or Senior Year

o Non–Matriculated may also apply, but priority goes to current Matriculated

o Must possess a G.P.A. of 2.5 or higher

o Must have completed at least 12 credits at SUNY Potsdam

o Must have approval from Experiential Education Director Toby White

o Must pass a Sit-up, Pushup and 1.5 mile run at the Cooper Standard 40

percentile

o Must pass an Interview with Academy Director Sonny Duquette

Note: There are no minimum or maximum age requirements for students. However, it should be

noted that pursuant to section 58 of the Civil Service Law, a candidate seeking permanent

appointment to a police officer title must be twenty years of age as of the date of appointment, and

not more than thirty-five years of age as of the date when the applicant takes the written examination.

Time spent on military duty or on terminal leave, not exceeding a total of six years, shall be

subtracted from the age of any applicant who has passed his or her thirty-fifth birthday.

SEATING PREFERENCE as seats are limited to 30:

o Matriculated SUNY Potsdam CJ students (and Hired SUNY Potsdam Police) get 1

preference.

o Then other SUNY Potsdam Majors interested in applying for the Pre-Employment Police Academy

o Then Non-Matriculated students and hired policed officers if seats are available.

*SUNY Potsdam students will have priority seating over all others.

INSTRUCTIONS FOR FILLING OUT APPLICATION:

Questions regarding the application should be sent to Director Duquette either by email at

duquetar@potsdam.edu

or Cell Phone at 315-261-8223

If any questions do not apply to you, please indicate so by N/A.

Answer all questions fully and truthfully.

A false statement made on this application may result in non-acceptance and could result in your

dismissal from the Academy if it is discovered later.

1. Candidates need to include scanned copies of the following items with their application:

a) Birth Certificate

b) College Course Summary from you Bear PAWS Account

c) Driver’s License ……… (must have at the time the application is submitted)

d) Armed Forces discharge papers (if applicable)

2. The last step of the application process is a P.T. test and an interview by the Police Academy Director. Director

Sonny Duquette who will contact you for a P.T. test and interview date.

Females: Sit-ups, Pushups, 1.5 Mile Run / Males: Sit-ups, Pushups, 1.5 Mile Run

Females: 32 15 14:50 / Males: 38 29 12:38

3. Director Duquette has the final say on who is accepted into the Academy and may turn away any applicant he feels

may be unsuitable for such training. Reasons may be based on a large multiple scale to include but not limited to:

Arrest Record, Disciplinary Record, Grade Point Average, Poor Physical Fitness, Poor Hygiene or Safety Training

Concerns for the Applicant OR for the other class participants, or no drivers’ license at the time the application is

submitted.

4. Applications are to be emailed to Director Duquette at duquetar@potsdam.edu. The medical

CERTIFICATE OF HEALTH form located in the application must be printed off and

signed by your Doctor, P.A or N.P and should be scanned and emailed with your application.

NOTE: You may hand in your application without the HEALTH CERTIFICATE if you so choose, as some medical

appointments may take weeks or months to get scheduled. Once you ultimately obtain the signature from your

medical provider, the form can then be emailed to Director Duquette. Be advised, failure to have this form prior to the

academy is an automatic dismissal.

(All information given in this application will be held confidential)

1. Name

(Last) (First) (Middle) (Suffix)

2. Physical Address

House Number Street/Road Village/Town Zip Code

3. Mailing Address (if different from Physical Address):

Home Email:

College Email:

4. Telephone: (_____) ______________________ P#

5. Social Security # _______ - ____ - _______ Date of Birth: _____/______/_______

Major: Minor:

Are you currently Junior or Senior?

Overall G.P.A.: Year and Semester you plan on graduating:

Number of credits completed to date (can find on Bear PAWS or BearDen):

What Semester are you planning on taking the academy?

(FALL semester of what year?)

If not selected this semester, are you able to complete the academy next year in your senior year?

Yes or no _______

Reason you answered NO:

6. Physical Characteristics

Height: Weight Lbs.: Sex:

7. U.S. Citizen: Yes or No

If not a U.S. Citizen, are your residing legally in the U.S.?

8. Place of birth (Town, State):

9. Do you possess a valid driver’s license? Yes or No________ (mandatory you have one

“now”)

State of License: Expiration of License:

Class Type: License Number:

10. Have you ever been arrested for a crime in any Country or State to include New York State or

have any pending charge in any Country or state to include New York State? Yes / No:

If yes, provide details (when, where, charge, what police agency, disposition):

11. Are you a Convicted Felon? Yes / No: ____

IF YES: Arrest conviction charge:

Police Agency:

Disposition (fine, time served, probation, parole):

12. Educational Qualifications: List the requested information concerning all high schools, colleges,

and universities which you have attended in chronological order, with the last institution attended

listed first and your high school last.

1. From – To: ____________________________

Name of Educational Institution:

Street Address: (City/Town/State):

Grade Point Average:

Collegiate Extra Curricular Activities:

Grades Attended:

Graduated: Yes / No:

Type of Degree or Diploma:

2. From – To:

Name of Educational Institution:

Street Address: (City/Town/State):

Grade Average:

Collegiate Extra Curricular Activities:

Grades Attended:

Graduated: Yes / No:

Type of Degree or Diploma:

3. From – To:

Name of Educational Institution:

Street Address: (City/Town/State):

Grade Average:

Collegiate Extra Curricular Activities:

Grades Attended:

Graduated: Yes / No:

Type of Degree or Diploma:

13. Have you ever served in the Armed Forces of the United States: Yes/No:

If yes: From: To:

Branch:

Type of Discharge:

What was your last rank?

Are you now serving or have you ever served in any reserve or National Guard unit? Yes / No: ____

If yes, give details:

Were you ever subjected to any disciplinary proceedings while in military service? (Include court

martial, summary proceedings, or Article 15 actions.) Yes / No:

If yes, give explanation (Date, Charge, Location, Disposition)

What types of training or education did you complete while in the military service? (Do not include

basic training.)

Were you ever the subject of any disciplinary action or proceeding at any education institution that

you attended? Yes / No: ________

If yes, give details:

14. Briefly state your reasons for desiring to attend the police academy:

15. If accepted into the academy, what address will you be residing / commuting from?

On Campus Yes / No:

Street: Town:

16. Are there any issues or concerns that the Police Academy Director should know about, such as

asthma, injuries, disabilities, personal issues, etc.

17. Medical Emergency Contact Persons:

Name: _____________________________ Number(s): _________________ / _________________

Address: _________________________________________________________________________

Email: ___________________________________ /_______________________________________

Name: _____________________________ Number(s): _________________ / _________________

Address: _________________________________________________________________________

Email: ____________________________________/______________________________________

SUNY POTSDAM POLICE ACADEMY

I understand that there may be hired police officers training along side of me in the SUNY Potsdam Police

Academy. I understand that they are referred to as Hired and I would be referred to as Pre-Employment. I understand

that Pre-Employment means I am taking the police academy prior to being hired in hopes that this will make me more

marketable to potential hiring agencies. In addition, I understand that a Municipal Police agency can save money by

hiring me once I’ve successfully completed this police training course as I already will have 93% of the required

police training mandated for every Municipal Police Officer hired within New York State.

I understand that I acknowledge the difference between Federal Policing like Border Patrol and the State

Police who both attend their own federal or state police academies. I understand that the SUNY Potsdam Police

Academy is a State Certified Municipal Police Training Academy in which this training may be used by any SUNY

Police agency, County Sheriff’s Department, City, Town or Village Police Department in New York State. And that

any Municipal agency can choose to accept this training once hired or opt to send me back through another Municipal

Police Academy should they so desire.

I understand that this training can or may be accepted anywhere in the country and the decision to accept all,

nothing, or portions of this police training is on a state by state consideration basis. I understand that there are

approximately 40 Municipal Police Academies in New York State. Out of those 40 academies, 11 are considered Pre-

Employment. I understand that this means these specific police academies are approved by New York State to train

both Hired and Pre-Employment. I understand that SUNY Potsdam is one of those 11 specific academies.

I understand that Pre-Employment cadets can get trained in 93% of the Certified Municipal Police Training in

New York state and that upon successful completion I will gain a stamped College Transcript from SUNY Potsdam

stating PRE-EMPLOYMENT BASIC POLICE TRAINING COMPLETED.

Dated:

Applicants Signature:

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SUNY POTSDAM POLICE ACADEMY

Due to state law, I understand that there are 4 components I cannot be trained in until I am officially hired and

that is: 1 week of Firearms, 4 hours of Baton, 7 hours of Basic Observations & Suspicious Activity Recognition, and

160 hours of Field Training Orientation (also known as hiring agency ride along). I understand that the 93% of the

training I will be receiving is referred to by New York State as Phase 1 and that the remaining 4 components (7%),

allowed only to hired Municipal Police Officers is referred to as Phase 2.

I understand that there are hundreds of possible “specialty topic” courses like Sniper, DARE, Bike Patrol,

Interrogation, Photography, etc. that are not mandated to be part of a New York State Basic Police Academy and it is

up to the hiring agencies to either send or not send their officers to any of these courses during the course of their

careers. Three of those such courses are Breathalyzer, Radar and Taser. I understand these are also considered

“specialty topic” courses as mentioned above and are not part of a Phase 1 academy. I understand that any of these

“specialty topic” courses may be added to any Phase 2 should any Police Academy Director opt to do so. I understand

that the SUNY Potsdam Academy Director has opted to offer these 3 courses in his Phase 2 to the hired officers.

I understand that my Phase 1 Training is 100% valid for 2-years from the day I graduate college, at which

point should I be hired by a Municipal Police Agency, I would only need to finish phase 2. I also understand that my

Phase 1 training is approximately 80% valid for up to 10-years. I understand that should I be hired by a Municipal

Police Agency wanting to use my police training past 2 years after college graduation but before 10 years of college

graduation, that I would have to take a refresher course of about 84 hours to update my certification. (Phase 2 is

generally all scheduled and paid for by the hiring agency and can be completed at any police academy in New York).

I understand that only hired police officers who completed both Phase 1 and Phase 2 are awarded police

certificates. And should I successfully finish Phase 1, my stamped College Transcript is my New York State legal

document attesting to that fact. Upon completion of a phase 2, in which I can take anywhere in New York State, I will

then receive a Police Certificate from the New York State Division of Criminal Justice / Office of Public Safety.

Dated:

Applicants Signature:

New York State Division of Criminal Justice Services

PRE-EMPLOYMENT POLICE BASIC TRAINING PROGRAM – STUDENT ADVISORY NOTICE

_________________________________________________________________________________________________________________

THIS FORM IS USED TO ENSURE STUDENTS ATTENDING A PRE-EMPLOYMENT POLICE BASIC TRAINING PROGRAM

HAVE BEEN ADVISED OF THE PROGRAM REQUIREMENTS AND RULES AND REGULATIONS GOVERNING TRAINING AND

APPOINTMENT AS A POLICE OFFICER.

FORMS PRESENTED FOR FILING MUST CONTAIN ORIGINAL SIGNATURES.

ALTHOUGH THE BLANK FORM MAY BE DUPLICATED, PHOTOCOPIES OF COMPLETED FORMS, OR FORMS

WITH PHOTOCOPIED SIGNATURES WILL NOT BE ACCEPTED.

Students in the Pre-Employment Police Basic Training Course must be advised of several conditions of this training program

that will affect them during and after attending the program. Schools are required to advise the student of these conditions by the

policy established for this program by Division of Criminal Justice Services.

1. Completion of this program is not a guarantee of employment as a police officer.

2. To complete this pre-employment training program, a student must participate in physical fitness training and successfully complete a

physical fitness examination.

3. To complete this pre-employment training program, a student must comply with mandated New York State regulations that include:

strict attendance requirements; maintaining a notebook; and passing written examination/s.

4. This is a two-phase program. The first phase is conducted pre-employment and the second phase is conducted after appointment as a

police officer. Each individual phase of this training program must be completed as a single and cohesive unit. This means that students

must complete the phase of the program at one institution. The following phase may be conducted at a separate institution.

5. Before being appointed as a police officer, a person must complete New York State Civil Service requirements and appointing agency

hiring standards (including minimum and maximum age and residency requirements) by taking a written examination and scoring high

enough on the eligibility list to be considered for appointment.

6. Before being appointed as a police officer, a person must take and successfully complete a physical fitness examination.

7. Before being appointed as a police officer, a person must submit to a medical examination, which may include drug screening.

8. Before being appointed as a police officer, a person may be required to submit to a psychological examination.

9. Before being appointed as a police officer, a person with criminal conviction or with a felony conviction may be disqualified from

employment.

10. Before being appointed as a police officer, a person may be required to submit to a background investigation.

11. Upon appointment as a police officer, a person will be required to successfully complete additional training. Failure to complete this

training will result in denial of certification by the New York State Municipal Police Training Council. This certification is required by §

209-q of the General Municipal Law for police officers to remain in their positions.

12. Pre-employment training will be valid for two years after completion of this program. If a person is not appointed before two years has

elapsed, they will be required to attend a Police Refresher Course. After ten years from the date of completion records on the transcript,

the training will no longer be valid (

this is consistent with the provision of §209-q of the General Municipal Law pertaining to police officers).

ATTESTATION Applicant Attestation: I hereby attest that I have read and understand the above policies regarding the Pre-

Employment Police Basic Training Program. I understand that the information in this section is part of a written statement that will be

presented to the Division of Criminal Justice Services for filing, and I certify that it is true to the best of my knowledge and belief.

Student Signature

Date

School Director Signature

Date

SUNY POTSDAM POLICE ACADEMY

I, __________________________________, being duly sworn, depose and say, that I am the person

whom the foregoing application concerns; that I completed the application in my own hand; and that

the answers I have given to each and every question therein are full, complete, and true and correct to

the best of my knowledge.

Dated:

Applicants Signature:

SUNY POTSDAM POLICE ACADEMY

AUTHORITY FOR RELEASE OF INFORMATION

(Background check of individual Criminal and Mental Health records)

This Authority for Release of Information, or copy thereof, constitutes my consent and

authorization to any person(s) duly accredited by, and representing the SUNY POTSDAM POLICE

ACADEMY to obtain any information in files which is relevant to my application for the police

academy. With my consent and authorization, any person(s) or organization is directed to furnish

such information upon request.

This Authority for Release of Information is executed with full knowledge and understanding

that the information is for official use only by the SUNY POTSDAM POLICE ACADEMY and

that the information will be safeguarded against unauthorized disclosure to any agency or individual

not having a legitimate need for it.

I hereby release any person(s) or organization, their employees, agents and officials from any

and all liability of whatever kind of nature on account of account compliance, or any attempts to

comply, with this Authority for Release of Information.

Dated:

Applicants Signature:

SUNY POTSDAM POLICE ACADEMY

Rules and Regulations Pre-Employment Cadets

Certification/Waiver Form

I, ______________________________________, hereby certify that I have received my personal

copy of the SUNY POTSDAM POLICE ACADEMY rules and regulations (located on this web

academy web page and will have with me on the 1

day of the academy if accepted) and have read

and fully understand the contents therein. I agree to abide by these rules and regulations as long as I

am enrolled as a pre-employment student. I also understand that my failure to abide by the academy

rules and regulations could lead to my termination from the SUNY POTSDAM POLICE

ACADEMY.

Dated:

Applicants Signature:

SUNY POTSDAM POLICE ACADEMY

CONFIRMATION OF UNDERSTANDING

• MATRICULATED STUDENTS ONLY

This form Does Not Apply to Non-Matriculated Students who are taking

Pre-Employment Basic Police Training Course as a Stand Alone Program.

I, ______________________________________, hereby certify that I understand that by taking the

PRE-EMPLOYMENT BASIC POLICE TRAINING Course here at SUNY Potsdam that to get credit

for this course I must graduate the Bachelorette Program. I understand that my PRE-

EMPLOYMENT BASIC POLICE TRAINING is good for Two (2) years starting from the date of

my Bachelorette Graduation and I also understand that if I was to withdraw from my Bachelorette

Program after completing the PRE-EMPLOYMENT BASIC POLICE TRAINING Course that this

will make such training Null and Void and I would not receive credit for this Pre-Employment Basic

Police Training course. I also understand that if I complete the Academy program but have yet to

graduate my Bachelorette program and am offered a position as a Municipal Police Officer prior to

my Bachelorette Graduation, that the academy will not be credited to me until such college

graduation.

Dated:

Applicants Signature:

SUNY POTSDAM POLICE ACADEMY

As listed on the student application packet posted and on the

SUNY Potsdam Police Academy website under

‘Program Costs’

(http://www.potsdam.edu/academics/appliedlearning/policeacademy/costs)

I acknowledge there is a separate $600 fee I must pay to attend this Police training. The Director of

the Academy will advise me of when that fee is due, and I fully understand that if I fail to

immediately pay this fee, I will be dismissed from the police training and will not gain any credit for

attending the academy.

This fee is to be paid if accepted into the police training and is

non-refundable regardless of course dismissal, failure or quitting.

I also understand that SUNY Potsdam will place a hold on all my academics, to include graduation,

until this fee is paid.

Dated:

Applicants Signature:

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SUNY POTSDAM POLICE ACADEMY

“CERTIFICATE OF HEALTH”

NOTE:

This form must be printed off and given to applicant’s medical provider.

This form must be completed by a Doctor,

Physician’s Assistant or a Nurse Practitioner ONLY.

I have examined (Applicants Name) ____________________________ and find that he/she is fit and

capable of engaging in strenuous physical activity of the nature required in law enforcement training;

which includes, but is not limited to daily physical training of long distance running, pushups, sit-ups

and various exercises of at least an hour, five days a week for five months. Training also includes 4-

hour wrestling days, high intensity and high stress reality-based training drills of active shooter,

running stairs, hallways, carrying training partners up and down stairs and other police activity.

Physician’s Signature Date

Physician’s License Number

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Email the completed application to Director Duquette at

duquetar@potsdam.edu

Be certain to have ALL REQUIRED DOCUMENTATION and the

Application filled out in its entirety as incomplete packets will be

placed at the bottom of the list for filling limited seats.

Reminder on documents to be scanned and added to this application:

a) Birth Certificate

b) College Course Summary from you Bear PAWS Account

c) Driver’s License……… (must have at the time the application is submitted)

d) Armed Forces discharge papers (if applicable)

e) HEALTH CERTIFICATE printed off and signed by your Doctor, P.A. or N.P. (no nurses!)

You ‘DO NOT’ hand in the

Rules and Regulations

located on the academy website.

However:

The Rules and Regulations must be printed off, read

and are for you to keep, study and follow if you are

eventually approved entrance into the

SUNY Potsdam Police Academy.

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