Blank Ad 5 Nevada PDF Template

The Ad 5 Nevada form is an application for the Intermediate Certificate issued by the Nevada Commission on Peace Officers’ Standards and Training. This form requires detailed documentation of an applicant's educational background, training hours, and relevant experience in law enforcement. Completing the Ad 5 form accurately is essential for certification; click the button below to begin filling it out.

Fill Out Ad 5 Nevada

Fill Out Ad 5 Nevada

Structure

The Ad 5 Nevada form is a crucial document for peace officers seeking to obtain an Intermediate Certificate, which signifies a certain level of training and education in law enforcement. This application, managed by the Nevada Commission on Peace Officers’ Standards and Training, requires detailed information about the applicant, including their name, POST ID number, and residence address. Importantly, it also requests documentation of college credits and specific training hours. Applicants must provide copies of official transcripts, detailing courses taken, terms completed, and the credits earned, particularly in areas such as English Composition and other relevant subjects. The form outlines a structured breakdown of required training hours, emphasizing the necessity of completing specific courses in skills, investigative techniques, human development, legal subjects, and elective training. Additionally, the form mandates signatures from both the applicant and an agency administrator or designee, ensuring that all information is verified and accurate. This comprehensive approach not only streamlines the certification process but also upholds the standards necessary for peace officers in Nevada.

Ad 5 Nevada Sample

STATE OF NEVADA

COMMISSION ON PEACE OFFICERS’ STANDARDS AND TRAINING

Records and Certification Section

5587 Wa Pai Shone Avenue Carson City, Nevada 89701

(775) 687-7678*Fax (775) 687-4911

INTERMEDIATE CERTIFICATE APPLICATION

Refer to NAC 289.240 for certificate requirements

Last Name

First Name

Middle

POST ID#

Residence Address (not agency address)

Street

City

State

Zip

Agency Name

Agency ID#

Hire Date

COLLEGE CREDIT DOCUMENTATION

(Copies of official transcripts required)

Subject

Term/Yr

College

Credits

3 Credits English Composition

3 Credits Other

Please itemize and include support documents of the training to include dates, college terms/quarters and hours in each area below.

200 HOURS – SPECIFIC TRAINING

Only courses that were passed can be used. College credits are converted at a ratio of 15 hours for each college credit.

40 HOURS - SKILLS OF OFFICERS

Course Topics (Include College Credits)

Hours

Course Topics Cont. (Include College Credits)

Hours

Subtotal

40 HOURS - INVESTIGATIVE SKILLS

Subtotal

40 HOURS - HUMAN DEVELOPMENT

Subtotal

40 HOURS - LEGAL SUBJECTS

Subtotal

40 HOURS – ELECTIVE TRAINING RELATING TO PEACE OFFICERS

Subtotal

Single Point of

Contact

Name

Signature

Title

Date

Agency Administrator

or Designee

Name

Signature

Title

Date

POST USE ONLY – DO NOT WRITE IN THIS SPACE

Date Reviewed

Reviewed By

Approved

Denied

Data Entry

1 of 1

Form AD-5 Intermediate Certificate Application R-06/2011

Click for Ad 5 Nevada PDF

File Attributes

Fact Name	Description
Governing Law	The Ad 5 Nevada form is governed by NAC 289.240, which outlines the requirements for obtaining an intermediate certificate.
Purpose	This form is used by peace officers in Nevada to apply for an intermediate certificate, demonstrating their training and qualifications.
Contact Information	Applicants can reach the Commission on Peace Officers’ Standards and Training at (775) 687-7678 for assistance.
Required Documentation	Copies of official transcripts are required to verify college credits and training for the application.
Training Hours	A total of 200 specific training hours is required, with college credits converted at a ratio of 15 hours for each credit.
Signature Requirement	The form must be signed by both the applicant and the agency administrator or designee to validate the application.
Sections of the Form	The form includes sections for personal information, college credit documentation, specific training, and skill areas.
Review Process	Once submitted, the application will be reviewed by POST staff, who will indicate approval or denial in the designated area.
Submission Method	The completed form can be submitted via fax or mail to the Records and Certification Section in Carson City.
Form Version	The current version of the form is AD-5, with a revision date of R-06/2011, indicating it may be updated periodically.

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