2. Strategic Response Team Application
4. Date*
   Date
6. First Name*
7. Last Name*
9. Date of Birth*
10. Height
11. Weight
13. Address 1
15. Address 2
17. City
18. State
19. Zip
21. Phone Number (Home)
22. Phone Number (Mobile)*
24. E-mail*
26. Date of Hire
27. Number of Sick Days in Last 12 Months*
28. Last Three Pistol Qualification Scores (With Date)*
30. Previously Failed Shotgun Qualification

    1. Yes
    2. No
31. Current Assignment and Supervisor(s)
33. Prior Military Service, If Any
34. Prior Law Enforcement Experience, If Any
36. Educational Background
38. If Extra Duty is Worked, List Location and Number of Hours Per Week
40. List All Written Discipline and Outcome
42. Marital Status

    1. Single
    2. Married
    3. Separated
    4. Divorced / Widowed
43. Number of Children at Home and Ages
45. Corrected Vision

    1. Yes
    2. No
46. Glasses / Contacts

    1. Yes
    2. No
47. List Any Hearing Problems
49. List Any Problems with the Following Areas (Including Old Injuries) Back, Knees, Ankles, Wrists, Elbows, Neurological or Psychological
51. List Any Prescription Medications
53. List Any Allergies
55. Explain Why You Are Applying for SRT
57. List Any Training You Feel May Be Beneficial to SRT
59. I understand that medical questions contained in this document are not disqualifiers for applicants, but merely indicators for necessary reasonable accommodations, if available. *

    1. Yes, I Understand
60. By submitting this form, I certify that the above information is true and correct to the best of my knowledge.*

    1. Yes, the above information is true and correct
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62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit Submit and Print

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