ADAPT - WELCOME

A.D.A.P.T.

INSTRUCTOR APPLICATION

(PLEASE COMPLETE AND HIT THE SUBMIT BUTTON AT THE BOTTOM OF THE PAGE)

 
EMAIL ADDRESS (required):
 
FIRST NAME:
LAST NAME: 
AGENCY NAME:
AGENCY ADDRESS: 
AGENCY PHONE NUMBER:
DIRECT LINE or EXT:
MOBILE NO.:
PREFERRED HOURS FOR RECEIVING TELEPHONE CALLS:
CURRENT RANK:
NO. OF SERVICE YEARS AS A PEACE OFFICER:
NO. OF YEARS AS A TCOLE CERTIFIED INSTRUCTOR:
PID NUMBER:
DOB:

Please answer the following written questions in as much detail as possible.

1. DESCRIBE ANY EXPERIENCE THAT YOU HAVE HAD IN PUBLIC SPEAKING OR TRAINING:

2. BRIEFLY DESCRIBE YOUR COMPUTER SKILLS, ESPECIALLY WITH MICROSOFT WORD AND POWERPOINT:

3. TCOLE LICENSE CERTIFICATIONS: (PLEASE CHECK ALL THAT APPLY)

4. LIST ANY OTHER CERTIFICATIONS OR TRAINING PERTINENT TO THIS SUBJECT:

5. ARE YOU SERVING AS A RESERVE OFFICER/DEPUTY?

6. BRIEFLY ELABORATE ON YOUR INTEREST AND EXPERIENCE IN THE FIELD OF ALCOHOL AND DRUG ABUSE PREVENTION ON COLLEGE CAMPUSES:

7. HOW LONG HAVE YOU BEEN A TRAINER/INSTRUCTOR FOR LAW ENFORCEMENT?

8. HAS YOUR PEACE OFFICER’S LICENSE EVER BEEN SUSPENDED OR REVOKED?

  IF YES, PLEASE EXPLAIN:

9. ARE YOU CURRENTLY IN COMPLIANCE WITH THE PEACE OFFICER CONTINUING EDUCATION REQUIREMENTS?

 IF NO, PLEASE EXPLAIN:

10 PLEASE LIST ANY COMMENDATIONS, PROCLAMATIONS OR AWARDS THAT YOU HAVE RECEIVED WHILE IN THE FIELD OF LAW ENFORCEMENT:

11. HAVE YOU EVER ATTENDED AN 8 HOUR ADAPT TRAINING CLASS?

  

12. ARE YOU A MEMBER OF A COALITION IN YOUR COMMUNITY? (Not a requirement and not limited to coalitions that are focused on underage drinking)

  IF YES, NAME: