HomeMy WebLinkAboutLPD Cert-Non Cert Affidavit_2022City of Lansing Department of Human Resources
Andy Schor, Mayor
Applicant’s Name: ______________________________________________________________
Social Security Number: _________________________________________
Driver’s License Number: ________________________________________ State Issued: __________
Fully Certified/Licensed Officers:
By signing this form, I am indicating that I am currently fully certified as a law enforcement officer under the provisions of
the Michigan Commission On Law Enforcement Standards.
I also understand that by signing, I retain the burden of proving my certification via the presentation of appropriate relevant
M.C.O.L.E.S. documentation at the time of application, as required by the Lansing Police Department.
_____________________________________________________ Date: _________________
(Signature)
Name of Police Academy attended: __________________________________________________
Academy Graduation Date: ________________________________
(Month and Year)
Out of State/Certifiable Officers:
By signing this form, I am indicating that I am currently certified as a law enforcement officer under the provisions of Law
Enforcement Standards set by the State in which I am licensed.
I also understand that by signing, I retain the burden of proving my certifiable status via completing MCOLES Recognition
of Prior Training and Experience (RPTE) program or testing and presenting the appropriate relevant documentation, as
specified at the time of the City of Lansing conditional job offer.
_____________________________________________________ Date: _________________
(Signature)
Name of Police Academy attended: __________________________________________________
Academy Graduation Date: ________________________________
(Month and Year)
Police Recruit or Civilian Applicants:
By signing this form, I am indicating that I am NOT currently certified or certifiable as a law enforcement officer under the
provisions of the Michigan Commission On Law Enforcement Standards.
_____________________________________________________ Date: _________________
(Signature)
2021
CERTIFIED/ OUT OF STATE LICENSED/
POLICE TRAINEE OR CIVILIAN
LPD APPLICANT AFFIDAVIT
Ellery Sosebee, Chief