Law Enforcement RegistrationNotification e-mail address must be agency affiliated. Please, no personal e-mail addresses.Please complete the form below, no partial applications accepted.
CONTACT INFORMATION(Type your name as it should appear on certificates of completion)First Name *Last Name *Position/Title/Rank: *Are you sworn law enforcement? * Yes No Phone Work: (###-###-#### - ext) *Mobile Phone: (numbers only) E-mail: * Use your agency address
WEBSITE ACCESSPassword: *Create a password for site access / modify your contact information(Minimum 8-characters 1-special 1-numeric)
Do you have Security Clearance?: Yes -Select-SECRETTOP SECRETN/A NoCleared Through:FBI DOD DHS N/AIf cleared through other state below:
AGENCY / ORGANIZATIONAgency/Organization Name: *
If your agency does not appear on the above list, complete the Full Agency Name below.Other Agency/Organization Name:Federal State Local MilitaryOtherOriginating Agency Identifier (ORI #) *City: *County: *- Select your county -AlamedaContra CostaDel NorteHumboldtLakeMarinMontereyNapaMendocinoSan BenitoSan FranciscoSan MateoSanta ClaraSanta CruzSonomaOtherState:*
P.O.S.T ID or N/A: *SUPERVISOR / EMPLOYMENT VERIFICATION CONTACTSupervisor Full Name:*Supervisor's Title:*Phone Work:* (###-###-####) Supervisor's Email Address:* (Organization email addresses only)Confirm Your Supervisor's Email Address:*
All registration information is considered strictly confidential and will not be shared with any other entity, law enforcement or otherwise.
2. I hereby acknowledge that I have read the attached document, titled "Safeguarding Sensitive but Unclassified Information" and a copy has been provided to me, and that I have received a security indoctrination concerning the nature and protection of FOUO information, including the procedures to be followed in ascertaining whether other persons to whom I contemplate disclosing this information have been approved for access to it, and that I understand these procedures. I also acknowledge that I have been advised that the NCRIC adheres to 28 CFR (Code of Federal Regulations) Part 23 guidelines, with respect to criminal intelligence files, and will only share criminal intelligence information with other law enforcement agencies that adhere to (same).
3. I have been advised that the unauthorized disclosure, unauthorized retention, or negligent handling of FOUO information by me could cause damage or irreparable injury to the NCRIC. I hereby agree that I will never divulge FOUO information to anyone unless: (a) I have officially verified that the recipient has been properly authorized by the NCRIC to receive it; or (b) I have been given prior authorization from the agency responsible for the information that such disclosure is permitted; or (c) the recipient has the "need to know" in order to perform their official, public safety duties. I understand that if I am uncertain about the classification status or handling control authority of information received from the NCRIC, I am required to confirm from an authorized NCRIC official that the information is FOUO before I may disclose it, except to a person as provided in (a) or (b) above.
4. I have been advised that any breach of this Agreement may result in the termination of my affiliation with the NCRIC.
5. I have read this agreement carefully and my questions, if any, have been answered.