Peace Officer Certification

APPLICATION FOR PEACE OFFICER CERTIFICATION

RCW 43.101.095 requires that as a condition of continuing employment as a peace officer, all Washington peace officers shall timely obtain certification as peace officers, or timely obtain certification for exemption therefrom, by meeting all of the requirements of RCW 43.101.095 and RCW 43.101.200. APPLICANT INFORMATION Legal Name: (Last, First, Middle Initial) Social Security Number

Current Agency

LAW ENFORCEMENT TRAINING [RCW 43.101.200] Training Course: Course Completion Date:

APPLICANT ATTESTATION [RCW 43.101.095 (2)] RCW 43.101.095 (2) requires each applicant for peace officer certification to complete a background Yes No investigation, psychological examination, and a polygraph test for the agency they currently work for. Please initial the appropriate box. I participated in a background investigation, to include submission of my fingerprints, for the agency listed above. I was administered a psychological examination for the agency listed above. I was administered a polygraph test for the agency listed above. CERTIFICATION INFORMATION RCW 43.101.105 explains that the Commission may deny or revoke certification of any peace officer, after written notice and hearing, based upon finding of one or more of the following conditions:  Failure on the part of the peace officer to meet all of the requirements under RCW 43.101.200.  The peace officer has knowingly falsified or omitted material information on an application for training or certification to the Commission.  The peace officer has been convicted at any time of a felony offense under the laws of this state or has been convicted of a federal or out-of-state offense comparable to a felony under the laws of this state.  The peace officer has been discharged for disqualifying misconduct, the discharge is final, and some or all of the acts or omissions forming the basis for the discharge proceedings occurred on or after January 1, 2002. “Discharge for disqualifying misconduct” is defined under RCW 43.101.010(8) and (9).  The peace officer’s certification was previously issued by administrative error on the part of the Commission.  The peace officer has interfered with an investigation or action for denial or revocation of certificate by: (a) knowingly making a materially false statement to the Commission; or (b) in any matter under investigation by or otherwise before the Commission, tampered with evidence or tampered with or intimidated any witness.

I attest that I have satisfied all the prerequisites to certification identified above. I have also reviewed and acknowledge the conditions which may lead to the denial or revocation of my certification.

I hereby authorize the release of my personnel files, termination papers, criminal investigation files, or other files, papers, or information that are directly related to any certification matter(s) that may come before the Commission to establish and maintain my certification as a peace officer in Washington State.

Furthermore, I understand that this is an application for certification to the Commission, and hereby attest that I have read and understand the requirements of RCW 43.101.095 and that I have met all of these requirements. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Signed this ______day of______, 20____, in______, Washington.

Applicants Signature:

Form CJ 1904 Submission via email [email protected] Revised: 08/17/17 Or Fax: 206-835-7923