OEMC / 911 CAD Onboarding & Credential Request

Requesting Office/Agency/Department *

First Name *

Middle Name *

Last Name *

Work Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone Number: *

Work Phone Number: *

Cell Phone Number: *

Cell Provider: *

Work E-Mail: *

Date of Birth: *

Sex: *

Race

Ethnicity

Driver's License Number: *

Driver's License State: *

Driver's License Expiration *

Driver's License Class *

Blood Type

Title/Rank: *

Division:

Section:

Employee ID Number: *

Radio Call Sign: *

Sworn *

Photo Submission

Please upload a current photo.

File Upload

Drag & Drop Files, Choose Files to Upload

Immediate Supervisor: *

Hire Date: *

Mobile Access Requests *

Access to Mobile CAD
Access to Field OPS

Please check all or none that apply.

LEADS Authorization

Please upload a PDF copy of your LEADS SID Number Request.

File Upload (copy)

Drag & Drop Files, Choose Files to Upload

Signature

Authorizing Official *

By my signature below I am requesting the person listed on this form to be entered into the Franklin County 911 Computer Aided Dispatch System. I attest that the person being entered has been subject to an extensive background investigation and they pose no security risks to the integrity of the system.

Date / Time *

Date

Time

Signature *

Clear Signature