Law Enforcement Training
Identification
Datatel ID# or SS#:
Confirm Datatel ID# or SS#:
Date of Birth:
Last Name:
First Name:
Middle Name:
Address
Street:
City:
State:
Zip Code:
County:
Contact Information
Telephone Home:
Telephone Work:
Telephone Cell:
Email Address:
Employment Information
Name of Employer:
Employment Status:
---
Employed
Full-Time
Part-Time
Unemployed
Retired
Agency Information
Name of Law Enforcement Agency:
Agency Status:
---
Full-Time
Part-Time
Volunteer
Current Position:
Street:
City:
State:
Zip Code:
Other Information
Race:
---
White
African American
Native American
Hispanic
Asian
Other
Education:
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High School
Adult High School
GED
1 Yr. Voc Diploma
Associate Degree
Bachelor Degree
Master Degree
PhD
Highest HS Grade Completed:
Last Year Attended HS:
Name of Last Highschool Attended:
Title of course you would like to register for:
Registering Course Start Date:
State if other than NC:
I certify that I am a sworn law enforcement officer in the state of North Carolina.
Additional Notes or Questions: