SOP 506.03-att-1: Basic Correctional Officer Training Request Form

SOP 506.03
Attachment 1

10/20/20
Page 1 of 2

# GEORGIA DEPARTMENT OF CORRECTIONS GEORGIA CORRECTIONS ACADEMY B.C.O.T. TRAINING REQUEST FORM

|TYPE OR PRINT|Col2|
|---|---|
|PRISON/CENTER:|TELEPHONE NUMBER:
|
|WORK LOCATION ADDRESS:
|WORK LOCATION ADDRESS:
|
|TRAINING OFFICER:
|DATE OF REQUEST:|

THIS REQUEST SHOULD BE COMPLETED AND FORWARDED THROUGH APPLICANT’S
TRAINING OFFICER TO THE GEORGIA CORRECTIONS ACADEMY. REQUESTS SHOULD BE
SUBMITTED NO LATER THAN TEN (10) DAYS PRIOR TO THE BEGINNING DATE OF THE
PROGRAM. CONFIRMATION LETTERS AND INSTRUCTIONS WILL BE SENT DIRECTLY TO THE
PERSONNEL DEPARTMENT.

|COURSE TITLE:|COURSE DATES:|Col3|Col4|Col5|
|---|---|---|---|---|
|NAME:
|NAME:
|NAME:
|RACE:|SEX:|
|MERIT SYSTEM TITLE:
|EMPLOYMENT DATE:|EMPLOYMENT DATE:|EMPLOYMENT DATE:|EMPLOYMENT DATE:|
|EMPLOYEE IDENTIFICATION NUMBER
(MANDATORY FOR STATE EMPLOYEES):


SOCIAL SECURITY NUMBER
(MANDATORY FOR NON-STATE EMPLOYEES):

|EMPLOYEE IDENTIFICATION NUMBER
(MANDATORY FOR STATE EMPLOYEES):


SOCIAL SECURITY NUMBER
(MANDATORY FOR NON-STATE EMPLOYEES):

|DATE OF BIRTH:



POST CERTIFICATION NUMBER
(IF APPLICABLE):

|DATE OF BIRTH:



POST CERTIFICATION NUMBER
(IF APPLICABLE):

|DATE OF BIRTH:



POST CERTIFICATION NUMBER
(IF APPLICABLE):

|
|Vendor ID # (Mandatory for travel Reimbursement):
|Vendor ID # (Mandatory for travel Reimbursement):
||||

# SEND TO: GEORGIA CORRECTIONS ACADEMY AT TIFT COLLEGE

BCOT POST UNIT
300 PATROL ROAD
FORSYTH, GEORGIA 31029

TELEPHONE NUMBER: 478-992-2837
FAX NUMBER: 478-992-5930

Retention Schedule: Upon completion, this form must be kept at local facility training offices and/or regional training offices until
storage capacity is exceeded. This form must then be boxed, labeled by location and year, and forwarded to the Academy
Director’s office for storage in Bay D, SOSTC Fleet Warehouse which is climate controlled. After retention for at least seven (7)
years, only the Academy Director may direct that this form be destroyed.

SOP 506.03
Attachment 1

10/20/20
Page 2 of 2

# ACCESSIBILITY ASSISTANCE

Please provide the following information so that appropriate accommodations can be made available to you at the Training
Program. Please remember that if a specific accommodation is not requested in advance, it might not be provided on site. Check
all categories that apply.

|IF YOU ARE HEARING IMPAIRED, IN WHAT FORM DO YOU PREFER TO RECEIVE COMMUNICATION?
(Choose one by placing an “X” in the block.)|Col2|Col3|Col4|
|---|---|---|---|
||ASL Interpreting||PSE Transliteration|
||Oral Interpreting||Tactile Interpreting|
|IF YOU WOULD LIKE TO USE AN ASSISTIVE LISTENING DEVICE, WHICH TYPE OF CONNECTOR
WOULD YOU PREFER WITH YOUR RECEIVER?
(Choose one by placing an “X” in the block.)|IF YOU WOULD LIKE TO USE AN ASSISTIVE LISTENING DEVICE, WHICH TYPE OF CONNECTOR
WOULD YOU PREFER WITH YOUR RECEIVER?
(Choose one by placing an “X” in the block.)|IF YOU WOULD LIKE TO USE AN ASSISTIVE LISTENING DEVICE, WHICH TYPE OF CONNECTOR
WOULD YOU PREFER WITH YOUR RECEIVER?
(Choose one by placing an “X” in the block.)|IF YOU WOULD LIKE TO USE AN ASSISTIVE LISTENING DEVICE, WHICH TYPE OF CONNECTOR
WOULD YOU PREFER WITH YOUR RECEIVER?
(Choose one by placing an “X” in the block.)|
||Headphones||Earphone|
||Telecoil Neck loop||Silhouette Pick Up Coil|
|IF YOU HAVE VISUAL OR COGNITIVE DISABILITIES, DO YOU NEED ANY OF THE FOLLOWING? (Choose
one by placing an “X” in the block.)|IF YOU HAVE VISUAL OR COGNITIVE DISABILITIES, DO YOU NEED ANY OF THE FOLLOWING? (Choose
one by placing an “X” in the block.)|IF YOU HAVE VISUAL OR COGNITIVE DISABILITIES, DO YOU NEED ANY OF THE FOLLOWING? (Choose
one by placing an “X” in the block.)|IF YOU HAVE VISUAL OR COGNITIVE DISABILITIES, DO YOU NEED ANY OF THE FOLLOWING? (Choose
one by placing an “X” in the block.)|
||Audiotape Program Booklet|Audiotape Program Booklet|Audiotape Program Booklet|
||Large Print Program Booklet|Large Print Program Booklet|Large Print Program Booklet|
||Braille Program Booklet|Braille Program Booklet|Braille Program Booklet|
||I will be bringing a personal assistant (e.g. attendant, facilitator, interpreter, etc.)|I will be bringing a personal assistant (e.g. attendant, facilitator, interpreter, etc.)|I will be bringing a personal assistant (e.g. attendant, facilitator, interpreter, etc.)|
|NOTE:
PLEASE LIST THE NAME OF YOUR PERSONAL ASSISTANT SO THAT A NAME


BADGE CAN BE MADE FOR HIM/HER. THE REGISTRATION FEE WILL BE


WAIVED FOR THIS PERSON.|NOTE:
PLEASE LIST THE NAME OF YOUR PERSONAL ASSISTANT SO THAT A NAME


BADGE CAN BE MADE FOR HIM/HER. THE REGISTRATION FEE WILL BE


WAIVED FOR THIS PERSON.|NOTE:
PLEASE LIST THE NAME OF YOUR PERSONAL ASSISTANT SO THAT A NAME


BADGE CAN BE MADE FOR HIM/HER. THE REGISTRATION FEE WILL BE


WAIVED FOR THIS PERSON.|NOTE:
PLEASE LIST THE NAME OF YOUR PERSONAL ASSISTANT SO THAT A NAME


BADGE CAN BE MADE FOR HIM/HER. THE REGISTRATION FEE WILL BE


WAIVED FOR THIS PERSON.|
|Name of Attendant:|Name of Attendant:|Name of Attendant:|Name of Attendant:|
|I HAVE THE FOLLOWING ACCOMMODATION NEED THAT WAS NOT LISTED ABOVE:|I HAVE THE FOLLOWING ACCOMMODATION NEED THAT WAS NOT LISTED ABOVE:|I HAVE THE FOLLOWING ACCOMMODATION NEED THAT WAS NOT LISTED ABOVE:|I HAVE THE FOLLOWING ACCOMMODATION NEED THAT WAS NOT LISTED ABOVE:|
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Retention Schedule: Upon completion, this form must be kept at local facility training offices and/or regional training offices until
storage capacity is exceeded. This form must then be boxed, labeled by location and year, and forwarded to the Academy
Director’s office for storage in Bay D, SOSTC Fleet Warehouse which is climate controlled. After retention for at least seven (7)
years, only the Academy Director may direct that this form be destroyed.