Agent Application | Certifying Agent Application |
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Agent Questionnaire PLEASE PRINT, FILL OUT, AND RETURN TO ADDRESS BELOW Please PRINT Clearly OR TYPE! Your Full Name: ____________________________________________________________________________ Address You Want Your Mail Sent To:____________________________________________________________ City: _____________________________________________________________State: ______ Zip:__________ Home Phone: ______________________________Email:___________________________________________ Your Age________Male_______Female________ Address Where Certifications Will Be Performed:____________________________________________________ City: ___________________________________________________________State: ________Zip:___________ What Type of Training & Certifications Can or Will You Perform? Narcotic Detection Yes [ ] No [ ] Patrol/Apprehension:Yes [ ] No [ ] Personal Protection. Do you have a bite suit? Yes [ ] No [ ] Tracking Yes [ ] No [ ] Search and Rescue Yes [ ] No [ ] Do you have a DEA license? Yes [ ] No [ ] Do you have narcotics at your disposal to certify with? Yes [ ] No [ ] Explain how_________________________________________________________ _________________________________________________________ Police Tracking/Evidence Search Yes [ ] No [ ] Bomb or Pyrotechnics Detection/Arson Investigation Yes[ ] No [ ]Temperament Testing (required for Patrol and Personal Protection Certifications) Yes[ ] No [ ] Are You Willing to Perform Certifications for Both Law Enforcement and Non-Law Enforcement Entities, Including Security and Detection Companies, Other K-9 Trainers and Private Citizens for Personal Protection? [ ] Yes [ ] No Your Kennel/Business Name: ___________________________________________________________________ Your Kennel/Business Address: __________________________________________________________________ City: _________________________________________________State: ________Zip: _____________________ Business Phone: ______________________________Email:__________________________________________ Web-site address:_________________________________________________________________________ Have You Trained For Law Enforcement Departments: [ ] Yes [ ] No Number of Years you have handled a K-9 for a Law or Private Security Department: _____________________ Number of K-9s You Have Trained: ________ What Type of Training Have You Performed and Equipment Have You Used? - Personal Protection/Patrol [ ] Muzzle Work [ ] Bite Suit [ ] Bite Sleeve [ ] - Do You Do Decoy Work? YES [ ] NO [ ] Narcotic Detection [ ] Bomb Detection [ ] Pyrotechnics [ ] Alcohol [ ] Tracking/Evidence Search [ ] Trailing [ ] Air Scenting [ ] Obedience [ ] French Ring Sport [ ] Schutzund I [ ] Schutzund II [ ] Schutzund III [ ] Other [ ] Describe: _________________________________________ _____ How Many K-9 Handlers Do You Train Each Year?: How Many Dogs Do You Keep At Your Facilities at the Same Time: ____ How Many K-9s Do You Own Personally?: ______ Please Give Three Personal References, Law Enforcement or Civilian, That We May Contact Regarding Your K-9 Training Experience: REFERENCE OF PEOPLE YOU PERSONALY TRAINED AND SOLD DOGS TO. Reference One:Name____________________________________________________ Full Address: ___________________________________________________________ City__________________________________________________Zip______________ Contact Phone Number:___________________________________________________ Breed Of K-9_____________________Type Of Training_________________________ ______________________________________________________________________ Reference Two: Name____________________________________________________ Full Address:___________________________________________________________ City_________________________________________________Zip_______________ Contact Phone Number:___________________________________________________ Breed Of K-9__________________________Type Of Training____________________ Reference Three: Name:___________________________________________________ Full Address:____________________________________________________________ City_________________________________________________Zip_______________ Contact Phone Number:___________________________________________________ Breed Of K-9________________________________Type Of training______________ _____________________________________________________________________ Brief Description of Yourself and/or Your Business: (for advertising purposes, use back of page if needed)
Can you hold seminars at your training kennel or at your location? YES [ ] NO [ ] Can you help at other training k-9 training seminars? YES [ ] NO [ ] What types of training can you give lectures on?:_______________________________ Protection/Patrol [ ] Narcotic Detection [ ] Tracking [ ] Trailing [ ] Air Scenting [ ] Bomb/Pyrotechnics/Firearm Detection [ ]Other [ ] Describe: Are you qualified to testify as an expert witness on the above types of training? YES [ ] NO [ ] -- If NO, are there any types of training you are qualified as an expert witness in? Please describe:
Are you interested in becoming an expert witness as a DRUGBEAT agent for court testimony? YES [ ] NO [ ] Are you willing to assist other K-9 handlers with their K-9 problems? YES [ ] NO [ ] Signed: ________________________________________________________Date: ______________________ Comments You May Have:
Are you willing to do a mailing to the law Departments of your state? Yes__NO__ Have you ever been convicted of a felony? Yes___No___ Please send copies of any schooling you have attended. AFTER COMPLETING ENTIRE FORM, ALONG WITH THE $150.00 Fee: PLEASE MAIL TO DRUG BEAT K-9 Certifications 4085 N Farm Road 249 Strafford, Missouri 65757 Phone 417 353-1596 E-mail: GDL040257@aol.com |
