CLEAR FORM - PDF document

1 CLEAR FORM Services Site. GEFENSE IOGHST
CLEAR FORM Services Site. GEFENSE IOGHSTHFSBATTIE FREEK,MHFHHGANLaw Enforcement Support Office (LESO)Application for Participation / Authorized Screeners Letter Page Full-time: Part-time: in the program. Indicatecompensatedofficers with RTD Screeners must be employed by the aforementioned LEA. Individuals identified below may request access to act as an Number Note: Email is needed for address (ifabove i.e. Terminal *Agency Name:*Agency Physical Fax #: Page *TITLE PRINTEDNAME: FIRST *SIGNATURE *DATE - The LESO Program defines this as a Governmental/activity whose primary function isapplicable Federal, State and Local lofficers havepowers of arrest and apprehension. I certify that mydefinition of a"Law Enforcement Agency/Activity" as described above. I certifythat allinformation contained in this applicationis valid and accurate. I understand that I mustprovideCoordinator an applparticipant information if thefollowing informatio

2 n changes:1. Chief Law Enforcement Offic
n changes:1. Chief Law Enforcement Official2. Agency physical address changes or 3. RTD Screener additions/deletions. I am signing this document as theCLEO of this lawIn my official position or as Acting/Interim, I am authorized to sign documents on behalf of the CLEO for this agency.If checked, please provide current department policy or Memorandum that provides such signature authority to the individual holding that official position. (Check only one): STATECOORDINATORS OFFICE USE ONLY As the State Coordinator/ State Point of Contact it has been determined that agency meets the definition of a "Law Enforcement Agency/Activity" as described certify that all information contained in this application is valid and accurate application, I certify that myerty, which states; With the of controlled property, the supervision of suchuse, and the evaluation of the effectiveness of such use, including foregoing is true and correct. 4 4