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Collects applicant identity, contact details, and date of birth, and requires disclosure of training entity selection and Certificate of Eligibility (COE) information. Includes applicant declaration regarding compliance with FSC guidelines, validity conditions for certification, and instructions for submitting the completed form and attachments. 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Certified Instructor Application  \n# □Initial Application\n\n□Renewal Application  \nDOJ Certified Instructor Number  \n\n| A.Applicant Information   |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Last Name:   |  | First Name:   |  |  | Middle Name:   |  |  |  |\n| Mailing Address:   |  |  | City:   |  |  |  | State:   | Zip Code:   |\n| Business Address (if different)   |  |  | City:   |  |  |  | State:   | Zip Code:   |\n| Date of Birth(mm/dd/yyyy):   | CA Driver License or Identification Card Number:   |  |  | Sex:   |  | Phone No.(include area code):   |  |  |\n| Email Address:   |  |  |  |  |  |  |  |  |\n\nPursuant to Penal Code section 31635,subdivision(b),Instructor Cerification from the Department requires training and certification from  \none of the following(select one training entity and attach a copy of the certification-initial applicants only):  \nDepartment of Consumer Affairs,State of California-Firearm Training Instructor.Director of Civilian Marksmanship,Instructor or Rangemaster.Federal Government,Certified Rangemaster or Firearm Instructor.  \nFederal Law Enforcement Training Center,Firearm Instructor Training Program or RangemasterUnited States Military,Occupational Specialty(MOS)as marksmanship or firearms instructor.National Rifle Association-Certified Instructor,Law Enforcement,Rangemaster,or Training Counselor.Commission on Peace Officer Standards and Training,State of California-Firearm Instructor or Rangemaster.Authorization from a State of California accredited school to teach a firearms training course.Training deemed equivalent by the Department.  \nAll applicants for Certified Instructor must have a valid Certificate of Eligibility (COE).An application for COE is acessible on the AttorneyGeneral's website at http://oag.ca.gov/firearms/forms.  \nCOE Number:  \n\n| B.Declaration   |\n| --- |\n| 「understand that the Department of Justice the Department)has no responsibility for insurance coverage for myself,my students,my classes,my  \u003Cbr>courses,or my oversight offirearm safe handling demonstrations.I understand that my instructor certification will be valid for five years providedI  \u003Cbr>maintain a curent COE.Iagree to comply with the Firearm Safety Certifcate (FSC)Program guidelines,procedures,and legal requirements as  \u003Cbr>specified in the applicable statutes and applicable regulations.I declare under penalty of periury under the laws of the State of California that the  \u003Cbr>foregoing is true and correct.   |\n| Signature  \u003Cbr>Date   |\n| NOTE:Only DOJ Cerified Instructors may administer FSC tests,issue FSCs,and overse the firearm safe handling demonstration.  \u003Cbr>(Pen.Code,SS26850,subd.(a)&(b),26853,26856,26859,26860,and 31645.)  \u003Cbr>Ifyou have any questions regarding the FSC Program,please contact the Bureau of Firearms at (916)227-3750.  \u003Cbr>Mail completed form and all required attachments to:  \u003Cbr>California Department of Justice  \u003Cbr>Bureau of Firearms-FSC  \u003Cbr>P.O.Box 160367  \u003Cbr>Sacramento,CA95816-0367   |\n| DOJ USE ONLY   |\n| Certified Instructor Number:_  \u003Cbr>Received Date:__  \u003Cbr>Processed By BOF:__   |\n\n# Privacy Notice\n\nAs Required by Civil Code§1798.17  \nCollection and Use of Personal Information.The Bureau of Firearms in the Department of Justicecollects the information requested on this form as authorized by Penal Code section 31635.The Bureauof Firearms uses this information to establish grounds for the issuance of the certificate indicated on thisapplication.In addition,any personal information collected by state agencies is subject to the limitationsin the Information Practices Act and state policy.The Department of Justice's general privacy policy isavailable at http://oag.ca.gov/privacy-policy.  \nProviding Personal Information.All the personal information requested in the form must be provided.This form willnot be processed for failure to provide all personal information ","cbCaiiw2KGS9d6vi","https://ap.wps.com/l/cbCaiiw2KGS9d6vi","pdf",2290718,"English","# Initial Application\n# Renewal Application\n# Applicant Information\n# Declaration\n# Privacy Notice","[{\"question\":\"What information is required from the applicant on this form?\",\"answer\":\"The form requests last name, first name, middle name, mailing and business addresses, date of birth, driver license or identification number, sex, phone number, and email address.\"},{\"question\":\"What training entities can applicants select for certification eligibility?\",\"answer\":\"Applicants select one training entity (e.g., specific California entities, federal government training, United States military MOS marksmanship/firearms instructor routes, NRA certified instructor routes, POST, or an accredited California school authorization) and attach the required certification copy as instructed.\"},{\"question\":\"How is instructor certification validity handled after approval?\",\"answer\":\"Instructor certification is valid for five years, provided the applicant maintains a current Certificate of Eligibility (COE) and agrees to comply with FSC Program guidelines, procedures, and legal requirements.\"}]","DOJ Certified Instructor Application - Firearm Safety Certificate Program | PDF",1791007860]