MCJA Crisis Negotiator Application/Recertification

Name of Applicant:_____________________________________________________________

Name of Criminal Justice Agency:_________________________________________________

Name of Chief Executive Officer:__________________________________________________

Calendar Year for Application/Recertification_______________________________________

Recertification_________	New Certification______ (new applicants must attach a copy of their Crisis Negotiator Training Program completion)

List of Requirements:

The Crisis Negotiator must be a full-time MCJA or Board certified law enforcement or corrections officer, per 25 M.R.S. §§ 2804-C(1) or 2804-D(1).

The Crisis Negotiator must be beyond probation with the sponsoring agency.

The Crisis Negotiator must be designated by the agency as the Crisis Negotiator.

The Crisis Negotiator must have successfully completed a Crisis Negotiator Training Program, as outlined in Specification S-25. Attach documentation

The Crisis Negotiator must have completed 40 hours of annual in-service training, in order to be recertified, as outlined in Specification S-25.

STATEMENT OF EMPLOYING OR SPONSORING AGENCY

Affiant attests that all the required Specification S-25 requirements have been met and authenticated. Documentation of compliance with all mandated standards under Specification S-25 has been compiled and will be retained by this agency. A copy of the documentation will be provided for the initial application to the MCJA. The recertification documentation will be made available for audit by the MCJA when and as required upon notification of inspection made to an Agency representative at a location to be agreed upon.

_____________________________________________	______________________________

Signature of Chief / Sheriff or Agency Head	Date

Personally-appeared the above-named ___________________________ and made oath to the truth of the foregoing statement.

_____________________________________________	Date: ______________

Notary Public (or other person authorized to take oath)