Criminal Charges Notification 8.21.2014 Page 1 of 1
TEXAS COMMISSION ON LAW ENFORCEMENT
6330 E. Highway 290, STE. 200, Austin, Texas 78723-1035
Phone: (512) 936-7700 Fax (512) 936-7714
http://www.tcole.texas.gov
CRIMINAL CHARGES NOTIFICATION (E-1)
Commission Rules §211.27, 211.28, 211.29
LICENSEE INFORMATION
1. TCOLE PID
2. Last Name
3. First Name. 4. M.I. 5. Suffix (Jr., etc.)
6. Last 4 #s of
SSN
7. Race / Ethnicity
American Indian or Alaskan Native Asian
Black Hispanic Multicultural White
8. Date of Birth
9. Gender
Male
Female
10. Driver’s License
State:
Num:
11. Home Mailing Address 12. City 13. State 14. Zip Code 15. Phone Number
CURRENT DEPARTMENT INFORMATION
16. TCOLE Agency No. 17. Appointing Agency
18. Agency Mailing Address
19. City
20. County
21. Zip Code
22. Phone Number
23. Type of appointment (Check all that apply)
Peace Officer. Licensed Reserve Off. Jailer Telecommunicator Public Security Off. Other (un-appointed)
ARREST INFORMATION
24. Date arrested or charged 25. Offense(s) Charged With (indicate felony or misdemeanor and class)
26. Name of Arresting Agency, Address, City , County, Zip Code, Phone Number
27. Licensee and employing agency must submit Criminal Charges (E-1) form (check one)
Licensee Employing Agency Arresting Agency must submit this form and all arrest reports
Licensee must submit: 211.27
(4) an arrest, charge, or indictment for a criminal offense above the grade of Class C misdemeanor or for any Class C misdemeanor involving the
duties and responsibilities of office or family violence, including the name of the arresting agency, the style, court, and cause number of the
charge or indictment, if any;
(5) the final disposition of the criminal action; and
(6)
receipt of a dishonorable or other discharge based on misconduct which bars future military service.
Arresting agency must submit: 211.28
When an agency receives information that it has arrested or charged an individual that is required to report under §211.27 of this title for any offense
above a Class C misdemeanor, or for any Class C misdemeanor involving the duties and responsibilities of office or family violence, the chief
administrator or their designee must report such arrest to the commission in the format currently prescribed by the commission within 30 business days
of notice of the arrest.
Employing agency must submit: 211.29
An agency shall notify the commission, electronically or in writing, within 30 days, when it receives information that a person under appointment with
that agency has been arrested, charged, indicted, or convicted for any offense above a Class C misdemeanor, or for any Class C misdemeanor
involving the duties and responsibilities of office or family violence.
I am authorized to certify the attached documents are true and correct copies of this agency’s public files of matters
observed, recorded, or maintained pursuant to a duty imposed by law.
__________________________________________________________________________________________________________________
Name (Type or Print) Title Signature Date
