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Jamaica Constabulary Staff CollegeAPPLICATION FOR ASSOCIATES, BACHELORS AND PROFESSIONAL PROGRAMMESSECTION A – PERSONAL DATA1. NameTitle Last Name/Surname First Name Middle Name(s)2. a) Former Name (if applicable)Title Last Name/Surname First Name Middle Name(s) b) Type of Former Name:Maiden (Prior to) DeedPoll3. Have you previously applied to the JCSC? 5. If answer to question 4 is yes, please state the following:YesNoa) Identification Number b) From (year) c) To (year) d) Programme4. Have you previously been a student at the JCSC?YesNo6. a) Permanent Address: Apt/Street/PO Box 7. a) Mailing Address (if different from 6): Apt/Street/PO BoxTown/Post Office Parish City/Town/Post Office Parish/Countyb) Contact Numberb) Name of Contact (if any)c) Email Address8. Gender9. Date of Birth (dd/mm/yyyy)10. Tax Number /National IDFemale Male______/______/____________11. Marital Status12. Religion/DenominationSingle Married Common LawLegally Separated Divorced Widowed13. Country of Birth/National of 14. Country of Citizenship 15. a) Country of Residence b) Duration(yrs.)16. a) Do you have a disability? (This information is needed in case special facilities are required)b) If yes, please specifyYesNo17. Emergency Contact Information:a) NameTitle Last Name/Surname First Name Middle Initial b) Relationship to Applicantc) Emergency Permanent Address Apt/Street/PO Box d) Emergency Contact Home/Permanent Phone( ) -e) Emergency Contact Cell Phone( ) -City/Town/Post Office Parish/County f) Emergency Contact Work PhoneState Zip/Postal Code Country( ) - Ext:18. How did you obtain information about the JCSC?JCSC Force Orders  Direct Mail  Employer  Internet MediaSchool/College Fair  School Visit  Other : Please specify _______________________________Programme applying for19.First Preference ---------------------------------------- Second Preference ---------------------------------------------

SECTION B – ACADEMIC RECORD20.List all subjects passed at CXC (CSEC) General Proficiency, CXC (CAPE) and GCSE Ordinary and Advanced LevelsExamining Body (e.g.CXC, Cambridge)Level Subject Grade DateAwarded(mm/yyyy)CXC (CSEC) General Proficiency and GCSE Ordinary Level subjects passedCXC (CAPE) Unit 1 & Unit 2 and GCSE Advanced Subsidiary & Advanced Level subjects passed21. List academic programmes or examinations for which you are currently preparing or awaiting examination results.Examining Body(e.g. CXC,Cambridge)Level Subject/Programme Grade Date Awarded22.List educational institutions attended and any other professional programmes or courses you have completed, which you wish to be used to satisfy theMatriculation Regulations of the Jamaica Constabulary Staff College.Institution Name & AddressFrom(mm/yyyy)To(mm/yyyy)Type of Programme(e.g. Cert/Dip)Subject Area/MajorClass ofAward___/___________/___________/___________/___________/___________/___________/___________/___________/___________/________23. Please list any sporting/community/cultural or social activities in which you have been involved.

24.Expected Source of FundingSECTION C – FINANCIAL RESOURCESGovernment (specify):__________________________ Loan Self Institution of OriginDonor (specify):_______________________________ Parents Award(specify):______________________________________________25. Will you be able to meet your financial obligation within the agreed time?YesNoSECTION D - EMPLOYMENT RECORD26.List employment information starting with your current joba) Name of Employerb) Name of EmployerDepartmentPosition/ RankAddress: Apt/Street/PO BoxDepartmentPosition/ RankAddress: Apt/Street/PO BoxContact Information:Contact Information:City/Town/Post Office Parish/County City/Town/Post Office Parish/CountyState Zip/Postal Code Country State Zip/Postal Code CountryFrom_____/______/___________To_____/______/____________From_____/______/____________To__________/______/_______c) Name of Employerc) Name of EmployerDepartmentPositionDepartmentPositionDepartmentDepartmentAddress: Apt/Street/PO BoxAddress: Apt/Street/PO BoxCity/Town/Post Office Parish/County City/Town/Post Office Parish/CountyState Zip/Postal Code Country State Zip/Postal Code CountryFrom_____/______/___________To_____/______/____________From_____/______/____________To_____/______/____________SECTION E – REFEREE INFORMATION27.Name Two Referees ( must be a senior supervisor, Justice of the Peace, Senior Police Officer, Minister of Religion or School Principal)a) Name of Referee b) Name of RefereeName of OrganizationPositionAddress: Apt/Street/PO BoxName of OrganizationPositionAddress: Apt/Street/PO BoxCity/Town/Post Office Parish/County City/Town/Post Office Parish/CountyState Zip/Postal Code Country State Zip/Postal Code CountryContact Information:Contact Information:

28. I hereby certify that I have read and understood the instructions and theinformation necessary for completing this application and that all statementsmade are true and complete. I intend to provide such fees as may be payable tothe Jamaica Constabulary Staff College. I understand that otherwise myadmission to or registration in the College may be revoked.SECTION F - DECLARATION16. This application is made with my consent and I intend to provide such fees asmay be payable to the Jamaica Constabulary Staff College._______________________________Signature of Applicant______/______/___________Date (dd/mm/yyyy)__________________________________Signature of Parent/Guardian______/______/____________Date (dd/mm/yyyy)FOR OFFICIAL USE ONLYDocuments Received:Original Documents Returned:Application FeeReceipt no.:__________________________Birth CertificateMarriage Certificate__________________________________ ______/______/____________Deed PollSignature of Applicant Date (dd/mm/yyyy) IdentificationTranscriptsCXC/GCE CertificatesReferee ReportsOther (specify):_________________________________________________________________________________ ______/______/____________Signature of Academic Coordinator Date (dd/mm/yyyy)OFFICIAL ASSESSMENT:Qualified:Other Qualifications:Refer for decision re Matriculation:Qualifying:Not Qualified:Sponsored Contributing:Re-entry: