Print this form then complete it in ink.
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Please complete this registration form and the summary below. You will receive a registration receipt with a permanent I.D. number which is to be used for all future communication with the Criminal Justice Testing Center.
| NAME ___________________________________________________________ SEX ___________ Last First Middle |
| ADDRESS __________________________________________ DATE ________________________ Street Apt. |
| ____________________________________________________ PHONE (___)__________________ City State Zip |
| DATE OF BIRTH _____________________ SOCIAL SECURITY #_________________________ |
| CITY & STATE OF BIRTH ________________________________________________________ |
| EYE COLOR __________ HAIR COLOR ___________ HEIGHT ___________ WEIGHT ___________ |
| CURRENTLY SERVING IN ARMED FORCES ? YES ______ NO _____ BRANCH __________________ |
| ARE/WERE YOU A CERTIFIED LAW ENFORCEMENT/CORRECTIONAL OFFICER? YES _____ NO ______ |
| CITY/STATE____________________________________________________________________________ |
MINORITY RECRUITMENT SUMMARY:
Please complete this portion of the form. This information is required by state and federal agencies for the purpose of assuring equal employment opportunity. The information is CONFIDENTIAL and will not be used in determining your employability.ETHNIC CATEGORY: PLEASE MARK ONLY CATEGORY WHICH APPLIES TO YOU:
WHITE (____)
Not of Hispanic origin - Persons having origins in any of the original peoples of Europe, North Africa or the Middle East.BLACK (____)
Not of Hispanic origin - Persons having origins in any of the black racial groups of Africa.HISPANIC (____)
Persons of Mexican, Puerto Rico, Cuban, Central or South America or other Spanish culture or origin, regardless of race.AMERICAN INDIAN OR ALASKAN NATIVE (____)
Persons having origins of any of the original peoples of North America and who maintain cultural identification through tribal affiliations or community recognition.ASIAN OR PACIFIC ISLANDERS (____)
Persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands and Samoa.