University of Texas System Police Peace Officer Appointment Index
Applicant Name:
Form DP-53
PID #:
DEFINITION: Reinstatement Exception–Having left employment from any UT institution within 180 days or less and is eligible for rehire.
Is this applicant a Reinstatement Exception? Yes
No
If yes, refer to Policy 401a, page 11 (XV.E) for required documents.
1
TCOLE Form L-1 Appointment Application
2
TCOLE Form L-2 Licensee Medical Condition (make sure both exam and drug screen boxes are marked.)
Physician’s Medical Report
Drug Screening Report (must be a10-Panel Drug Screen)
3
TCOLE Form L-3 Licensee Psychological and Emotional Health Declarations
Physician’s Psychological Report
4
Copy of Current, valid driver’s license (picture must be discernible)
Copy of current automobile Insurance
CCH Return (TCIC/NCIC)
Driver’s License Return (10-27)
5
TCOLE Form F-7 (College Education Request)
Certified copies of college transcripts
6
7
8
9
10
DL Expiration Date:
/
/
Already on file (printout from TCLEDDS)
Not Applicable
Copy of
High School Diploma or
Transcript or
GED Certificate
TCOLE F-5R (Request through ODOP, must be filled out completely by investigator & included in packet)
Weapons Qualifications (Previous 12 months)
Copy of Selective Service registration verification
Not Applicable
Copy of military discharge papers
Not Applicable
DD-214 (member 4 page, showing reenlistment code)
Not Applicable
Verified by:
on / /
Fingerprint Applicant Services of Texas (FAST) Receipt (Serves as Affidavit prior to receipt of returns)
FAST fingerprint returns showing record checks through FBI and DPS (from FACT Clearinghouse)
Certified documents from the appropriate authority showing the final disposition of each arrest, probation,
community supervision, conviction or other criminal history or certified letter of non-prosecution.
Not Applicable if none of the above
Original or certified copy of Birth Certificate (Copy must also be signed and dated by person verifying it.)
Verified by:
on / /
Copy of Social Security Card
Certified copy of U.S. Citizenship Papers
Not Applicable
11
DP-38 Authorization for Release of Personal Information
12
DP-06 Evidence Organizer and Report of Background Investigation
13
DP-01 Personal History Statement
14
DP-36 Assumption of Risks, Covenant Not to Sue
DP-37 Physical Agility Test
15
DP-12 Interview Board Results
16
DP-05 Polygraph Authorization
DP-04 Pre-Employment Polygraph Questionnaire
Polygraph Report
17
DP-02 Conditional Offer of Employment
18
Credit Report with Credit Score
PREPARED BY:
DATE:
/
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