Ontario County, NY · Ontario County
Peace Officer Registry Entry Form – Certification of Initial Employment
This form registers a newly appointed or transferred peace officer with the Division of Criminal Justice Services and is completed by the registrant and employing officials.
At a glance
- Issued by
- City of Ontario County · Ontario County, Ontario County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- ontariocountyny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Peace officer employers use this form to register initial appointments and transfers with the Division of Criminal Justice Services. The registrant completes Section I, and agency and civil service officials complete the applicable sections; Section IV is for public officers and records the oath of office. The form asks for personal, agency, appointment, civil service, and oath information, and requires original signatures.
Who needs it
Peace officer employers submit this form for initial appointments and transfers, with sections completed by the registrant and the applicable agency, civil service, and oath-recording officials.
How to submit it
Mail completed forms to the NYS Division of Criminal Justice Services, Office of Public Safety – Records Unit, 80 South Swan St., 3rd Floor, Albany, NY 12210-8002.
About notarization
This form does not require notarization; Section IV records the public officer’s oath of office, administered and recorded by an eligible official.
How to submit this form
- 1
Download the Form
Download the Peace Officer Registry Entry Form for initial appointments or transfers.
- 2
Complete the Applicable Sections
Have the registrant and applicable agency, civil service, and oath-recording officials complete their sections.
- 3
Sign and Date
Each applicable signer should read the certification and sign and date the form. Original signatures are required.
- 4
Mail the Form to DCJS
Mail the completed form to the DCJS Office of Public Safety – Records Unit at the Albany address listed in the instructions.
Frequently asked questions
- Do I need a notary for the Peace Officer Registry Entry Form?
- No. The form does not require notarization. Section IV records a public officer’s oath of office, administered and recorded by an eligible official.
- How do I submit the Peace Officer Registry Entry Form?
- Mail the completed form with original signatures to the DCJS Office of Public Safety – Records Unit, 80 South Swan St., 3rd Floor, Albany, NY 12210-8002.
- Who completes the form?
- The registrant completes Section I. The chief law enforcement officer completes Section II, and a civil service officer completes Section III for municipal and state employees. Section IV applies to public officers.
- Are photocopies of completed forms accepted?
- No. The instructions state that forms presented for filing must contain original signatures; photocopies of completed forms or signatures will not be accepted.