Police Officer Supplemental Application Form
Name: ____________________________________________________________
(Last) (First) (Middle)
Check all that apply:
I hold a full-time MN POST Peace Officer’s License (Lic No.) _______
I have received a letter advising I am MN POST license eligible (date) ________
I have completed MN POST SKILLS and will take the Lic. exam on (date) ________
I am currently enrolled in the Minnesota POST SKILLS program.
I will graduate from SKILLS on (date):___________________
I am currently working as a full-time sworn peace officer in another state
I have served as an active duty military police officer
Have you ever been convicted of a felony?
Yes No
Have you ever been convicted of an offense listed in Minnesota Rules 6700.0300,
Subp. 5?
Yes No
Do you have a valid driver’s license?
Yes No Issuing State: ________________________
Check those violations that you have been convicted of within the last 10 years:
DWI Careless Driving Driving After Suspension
Reckless Driving Driving After Revocation
Have you served as a full-time paid law enforcement officer, with arrest authority?
Yes No
If yes the number of years:
Less than 1 year
1-3 years
3-5 years
5+ years
Check each position that you have held for a period of 6 months or longer:
Licensed Peace Officer
Community Service Officer or Police Cadet
Jailer (Not full-time licensed)
Part-time police officer/deputy (paid or volunteer)
Police Reserve Officer/Deputy (volunteer)
Water Patrol Officer (Not full-time licensed)
Park Ranger
Police/Sheriff radio dispatcher
