Peace Officer Standards & Training
P.O. Box 700, Meridian, ID 83680-0700 (208) 884-7250 http://www.idaho-post.org Fax (208) 884-7295
TERMINATION/CHANGE IN STATUS FORM
This form must be completed and submitted to the Peace Officer Standards & Training within fifteen (15) days of action. Please type or print information. Incomplete forms will be returned. 1.Agency 2. Date Employed 3. SSN
(mm/dd/yy)
4. Last Name 8. Home Mailing Address
5. First Name 9. City
6. Middle Name 10. State
7. Date of Birth
(mm/dd/yy)
11. Zip
12. Position (check one): Juvenile Detention 13. Status (check one):
CHECK ONE
Patrol Investigation Dispatch Juvenile Probation Marine Deputy Full-Time Part-Time
Detention Corrections
Jail Tech Other:
Reserve
14. TYPE OF ACTION (Enclose reports regarding disciplinary action.
PLEASE NOTE: Providing this information does not make you or your agency a party to any action the POST Council might take). Resigned Resigned* as a result of disciplinary action – Reason Enclose reports regarding disciplinary action. Do you recommend de-certification? Dismissed – Reason Terminated* as a result of disciplinary action – Reason Enclose reports regarding disciplinary action. Do you recommend de-certification? Retired: Regular Medical
DATE OF ACTION
(mm/dd/yy)
Retired* as a result of disciplinary action - Reason Enclose reports regarding disciplinary action. Do you recommend de-certification? Deceased Name Change From To To
Transfer Position – From Other – Please specify
15. Did the Officer take another job in law enforcement? If yes, was the job within the State of Idaho? Yes
Yes No
No If yes, which Agency?
I hereby certify to the best of my knowledge the information submitted on this form is true and correct.
Date _____________
For POST Use Only
Signature of Agency Head __________________________________________
Processed by __________________________________ Date ______________ Comments ____________________________________
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