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MPO_RLE 09-I (01-2016) Supersedes previous version dated 9-2009.
COMMONWEALTH OF PENNSYLVANIA MUNICIPAL POLICE OFFICERS' EDUCATION AND TRAINING COMMISSION
http://www.psp.pa.gov/MPOETC
8002 Bretz Drive Harrisburg, PA 17112-9748
CERTIFIED LAW ENFORCEMENT FIREARMS INSTRUCTOR
APPLICATION TO BE INCLUDED ON THE LIST OF CERTIFIED LAW ENFORCEMENT FIREARMS INSTRUCTORS AUTHORIZED TO CONDUCT FIREARMS QUALIFICATIONS FOR ACTIVE DUTY LAW ENFORCEMENT OFFICERS IN PENNSYLVANIA
INSTRUCTIONS
1. PROVIDE ALL REQUIRED INFORMATION IN BLOCKS 1 - 13.
2. DIGITALLY SCAN COPIES OF CERTIFICATE(S) FOR ANY TRAINING REPORTED IN BLOCK 8-11.
3. SUBMIT APPLICATION AND SUPPORTING DOCUMENTS VIA EMAIL TO THE MUNICIPAL POLICE OFFICERS’EDUCATION & TRAINING COMMISSION AT
APPLICANT CONTACT INFORMATION 1. LAST NAME FIRST NAME MIDDLE INITIAL 2. DATE
3. ADDRESS CITY STATE ZIP 4. DATE OF BIRTH
5. PHONE NUMBER 6. EMAIL ADDRESS 7. COUNTY
POLICE/LAW ENFORCEMENT FIREARMS INSTRUCTOR TRAINING 8. NAME AND PROVIDER OF BASIC/INITIAL FIREARMS INSTRUCTOR TRAINING COURSE 9. DATE COMPLETED
12. SELECT THE LAW ENFORCMENT OFFICERS FOR WHOM YOU ARE/WERE AUTHORIZED TO CONDUCT QUALIFICATIONS:
PENNSYLVANIA STATE POLICE MUNICIPAL POLICE
OFFICE OF THE SHERIFF GAME COMMISSION
FISH AND BOAT COMMISSION OFFICE OF ATTORNEY GENERAL
CONSTABLES PARK RANGERS AND FOREST OFFICERS
OTHER LAW ENFORCEMENT AGENCY/OFFICERS:__________________________________________________________
RETIRED LAW ENFORCEMENT QUALIFICATION 13. IN ACCORDANCE WITH THE FEDERAL LAW ENFORCEMENT OFFICER SAFETY ACT AND THE PENNSYLVANIA RETIRED LAW ENFORCEMENT IDENTIFICATION ACT, ALL FIREARMS INSTRUCTORS AUTHORIZED TO CONDUCT FIREARMS QUALIFICATIONS FOR ACTIVE DUTY LAW ENFORCMENT OFFICERS ARE AUTHORIZED TO CONDUCT FIREARMS QUALIFICATIONS FOR QUALIFIED RETIRED LAW ENFORCMENT OFFICERS. MPOETC PUBLISHES A LIST OF FIREARMS INSTRUCTORS WISHING TO CONDUCT ANNUAL FIREARMS QUALIFICATIONS FOR RETIRED OFFICERS. PLEASE INDICATE BELOW IF YOU WOULD LIKE YOUR CONTACT INFORMATION LISTED ON THE PUBLIC PAGE FOR RETIRED LAW ENFORCMENT OFFICER QUALIFICATIONS.
YES, PLEASE INCLUDE MY CONTACT INFORMATION ON THE PUBLIC RLEIA FIREARMS INSTRUCTOR LIST.
NO, DO NOT PUBLISH MY CONTACT INFORMATION.
10. RECEIVED INSTRUCTOR TRAINING FOR
HANDGUN SHOTGUN PATROL RIFLE
11. MOST RECENT REFRESHER TRAINING/QUALIFICATION
