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Advanced Training This 20 Hr. course will make the security officer compliant with 4749.10 Ohio Revised Code. This course will consist of: course of fire, rules of engagement, use of force.

OPOTC requirements state that each individual qualify within 200 rounds, if you do not qualify within the 200 rounds you do not pass the Firearms Training. If you are using your own Semi-Automatic weapon you should bring a holster, ammo, and two magazines and pouch. If you are using your own Revolver weapon you should bring a holster, speed loader and pouch.

DATES

(Select one of the above dates and enter the start date on registration form).

CLASS SIZE Minimum – 5 / Maximum - 20

FEE $250.00

TIME Friday 1800-2200 (6-10pm); Saturday and Sunday 0800 – 1700 (8am-5pm)

LOCATION

Western Campus KeyBank Public Safety Training Center, Range 11000 Pleasant Valley Road Parma, Ohio 44130

CONTACT

Carrie Havens, Coordinator carrie.havens@tri-c.edu Office (216) 987-3033 Fax (216) 987-0639

APPLICATION DEADLINE:

Six (6) business days prior to the start of the class.

ATTENDANCE REQUIREMENT: Perfect attendance for the course is a requirement, per OPOTC regulation. If you miss more than 14 minutes you will not be permitted to complete the class (NO refund will be given). Make-up is $25 per half hour (1-14 minutes equals a half hour of make-up).

DRESS CODE: You will need to wear pants (no wholes) with belt loops, a belt and non-slip shoes. It is suggested that you wear a long sleeve shirt.

ARRESTS AND/OR CONVICTIONS: Any felony conviction (including any arrests/convictions that you or an attorney have had expunged/sealed by the court) may prohibit you from entering the Academy. Note: Applicants who want to be certified to carry a firearm must NOT have a criminal record, to include domestic violence or any conviction of a lesser offense or plea where the original charge was domestic violence. Please answer the questions on page 2 honestly. If you answer yes to any of the questions you CANNOT take this class.

BACKGROUND CHECK: A complete background check is required.* Background checks are scheduled and are conducted by the Tri-C Public Safety Training Center office. Applicant must take the following documents with them for their WEBCHECK appointment: driver’s license or state ID and Social Security card.. Fingerprints will be taken electronically. Payment of $60 is made via Money Order only. No cash will be accepted.

You must call the Tri-C Public Safety Training Center at 216-987-3031 for an appointment.MUST BE COMPLETED no later than ten (10) business days prior to the start of the class.

*If your employer has completed a recent background check, we will accept a letter on company letterhead, signed by your supervisor, stating that there isn’t anything in your background.

ACADEMIC AND FINANCIAL STANDING: Each applicant must be in good academic and financial standing at the college. If you have any doubt that you meet this requirement, contact the Admissions Office at any campus to inquire if there are any holds on your student account.

FINANCIAL AID: Financial aid is NOT available for this training.

20 Hr. Private Security Firearms

Information in this application packet it subject to change without prior notice.

Revised 08/05/2020

February 19 - 21

April 16 - 18

June 18 - 20

Aug. 20 - 22

Oct. 15 - 17

Dec. 17 - 19

If you answer yes to any of the below questions you cannot take this course.

1. Have you ever been convicted of a felony offense in any jurisdiction, including any convictionthat has been sealed or expunged? (If so, you may not attend any portion of a Peace Officer BasicTraining Academy.)

2. Are you a fugitive from justice?

3. Have you ever been convicted of a felony offense of violence as defined in ORC 2901.01?

4. Have you ever been adjudicated a delinquent child for the commission of an offense that, if

committed by an adult, would have been a felony offense of violence?

5. Have you ever been convicted of any felony offense involving a drug of abuse?

6. Have you ever been adjudicated a delinquent child for the commission of an offense that, if

committed by an adult, would have been a felony offense involving a drug of abuse?

7. Are you drug dependent, in danger of drug dependence, or a chronic alcoholic?

8. Are you under adjudication from any court for mental incompetence?

9. Have you been adjudicated by a court as a mental defective?

10. Have you been committed by a court to a mental institution?

11. Have you been found by a court to be a mentally ill person subject to hospitalization by court

order, or have you been an involuntary patient other than one who is a patient only for purposes of

observation?

12. Have you ever been convicted of a crime that had a possible sentence of more than one year?

13. Are you an alien, illegally or unlawfully in the United States?

14. Have you been discharged from the Armed Forces under dishonorable conditions?

15. Have you renounced your United States citizenship?

16. Are you under a court order that restrains you from harassing, stalking, or threatening an intimatepartner or the child of such intimate partner, or engaging in other conduct that would place anintimate partner in reasonable fear of bodily injury to the partner or child?

17a. Have you been convicted of a misdemeanor crime of domestic violence?

17b. Have you been convicted of a misdemeanor crime that has, as an element of that crime, the use or

attempted use of physical force, or the threatened use of a deadly weapon?

If yes, please explain your relationship with the victim (stranger, present or former spouse, household member, child, other family member, other – please describe).

_________________________________________________________________________________________

_________________________________________________________________________________________

NO YES

Public Safety Training CenterLaw Enf orcement

Advanced Trai ning Programs

OPOTC TRAINING INFORMATION FORM

TYPE OR PRINT LEGIBLY IN BLACK OR DARK BLUE INK - FILL IN ALL SECTIONS

NAME: SSN:_____ - ____ - _______ LAST FIRST MIDDLE NAME (FULL)

HOME ADDRESS: STATE ZIP COUNTY

MALE

STREET CITY

HOME PHONE: (______)__________________________ CELL PHONE: (______)

E-MAIL ADDRESS:

D.O.B. (MM/DD/YYYY) __________________________________________________

PLACE OF BIRTH: _____________________________________________________ U.S. CITIZEN:

CITY COUNTY STATE

DRIVER’S LICENSE NUMBER: _________________________________ ISSUING STATE: _____________________

LICENSE EXPIRATION DATE: ________________________________ CURRENTLY SUSPENDED? No Yes

AGENCY INFORMATION: EMPLOYING AGENCY: PHONE: (______)

AGENCY ADDRESS: STREET CITY STATE ZIP COUNTY

DATE OF APPOINTMENT/EMPLOYMENT: POSITION/TITLE:

PLEASE CHECK APPROPRIATE BOX:

RACE: American Indian/Alaska Native Black/African American Asian Hispanic/Latino

Native Hawaiian/Pacific Islander White Other

PLEASE CHECK ONLY THE HIGHEST LEVEL OF EDUCATION:

ACADEMY FOR WHICH YOU ARE ENROLLING:

Choose one: Corrections Academy

20 Hr. Private Security Firearms

Court Officer Bailiff Firearms Training

Private Security Firearms Re-qualification

Private Security Firearms Only

Choose one: Utilizing my own weapon and ammo Utilizing Tri-C's weapon and ammoChoose one: Semi-Automatic Revolver

My signature signifies that all information contained in this application and any accompanying documentation is factual and is a true representation of me.

__________________________________________________________________________________ ____________________________________ STUDENT SIGNATURE DATE

FEMALE

No Yes

High School Diploma GED

Date of Birth: - -

Month Day Year

COURSE NO. COURSE TITLE START DATE FEE

PUBLIC SAFETY TRAINING CENTER: ADVANCED TRAINING REGISTRATION

BY PHONE: (216) 987-3033Police Agility Exam, Written Cognitive, and/or Pre-Screening Psychological Assessments ONLY.Credit card only- have your payment information available

BY MAIL:Credit card, purchase order, check or money order to: Cuyahoga Community CollegeKeyBank PSTC, ATTN: Carrie Havens11000 Pleasant Valley RoadParma, Ohio 44130-5113*Tri-C is not responsible for lost or misdirected mail

BY FAX: (216) 987-0639Credit card or Department purchase order only

Name on CardSecurity Code

Exp. Date

Name __________________________________________________________________Last First FULL Initial

SS# - REQUIRED

Department Name _________________________________________________________

Address ________________________________________________________________Number Street

___________________________________________________________________________________City State Zip County

Ethnic Background:

BLACK AMERICAN INDIAN OR ALASKAN

WHITE (NON-HISPANIC)

HISPANIC

ASIAN, PACIFIC ISLANDER, OR INDIAN SUBCONTINENT

Phone - -

Area Code Ext.

Fax - -

Area Code

Address ________________________________________________________________Number Street Apt. No.

____________________________________________________________________________________ City State Zip County

Home Phone

- -

Area Code

CellPhone

- - Area Code

Check or Money Order (enclosed & payable to Cuyahoga Community College)

IN-PERSON:Credit card, purchase order, check or money order at our Western Campus, Public Safety Training Center located at:7029 Homewood AvenueParma Heights, Ohio 44130

REGISTRATION OPTIONS

PERSONAL INFORMATION

Email _________________________________________________________________

EMPLOYMENT INFORMATION Complete this area if you are testing for a Department/Agency

PAYMENT INFORMATION

Signature (required) TOTAL

Gender: Male U.S. Citizen: Yes No

Female Are You a Veteran: Yes No

IMPORTANT PAYMENT INFORMATION

Effective July 15, 2014, a 2.4 percent service fee will apply to all payments made by credit card for Cuyahoga Community College (Tri-C®) tuition, fees and other student account charges.

REGISTRATION / CANCELLATION DEADLINES:Police Agility Exam, Written Cognitive, and/or Pre-Screening Psychological Assessments each have deadlines of 4PM the Wednesday prior to the Assessment date. ALL OTHER Advanced Training courses have deadlines of one (1) week prior to their start dates.

REFUND POLICY:Participants will receive a full refund if cancelled by the registration deadline date. There will be NO refunds thereafter. If you register for the test and do not cancel by the registration deadline, you WILL be billed for the test.

PARKING:Available in front & back lots of the KeyBank Public Safety Training Center building on Western Campus.

DIRECTIONS TO CAMPUS:Exit I-71 at Bagley Road and go EastExit I-77 at Pleasant Valley Road and go WestExit the Ohio Turnpike at Exit 10 to I-71 NorthThe Campus is located at the corner of Pleasant Valley and York Roads.

Have you ever been convicted of a sexual related offense or a violent crime against a minor? Yes No

REGISTRATION INFORMATION

OTHER

APPLICANTS WILL NOT BE SENT NOTIFICATIONS OR CONFIRMATIONS.

Bill Department, (via attached P.O. or 3rd Party Authorization Form)

Mastercard

Visa

Discover

Amer. Express Signature

Account Number

SCAN TO EMAIL: Carrie.Havens@Tri-C.eduCredit card or purchase order only

20 Hr. Private Security Firearms Qualification $250.00