GEORGIA DEPARTMENT OF CORRECTIONS



GEORGIA DEPARTMENT OF CORRECTIONS

TRAINING REQUEST FORM

PLEASE TYPE OR PRINT

This request should be completed and forwarded through the applicant’s training officer. All requests are to be submitted with all required signatures no later than 30 days prior to the beginning date of the class. Confirmation letters and instructions will be sent directly to the appliciant.* Incomplete requests will not be honored. * Confirmation letters/instructions will be emailed directly to applicants.

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|PRISON/CENTER/OFFICE: |EMPLOYEE NAME: |

| |EMPLOYEE IDENTIFICATION NUMBER (MANDATORY FOR STATE EMPLOYEES): | |

|OFFICE ADDRESS: | |EMPLOYMENT DATE: |

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|EMAIL ADDRESS: | | |

| |SOCIAL SECURITY NUMBER | |

| |(MANDATORY): | |

| | | |

| |OFFICER O KEY # : | |

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|VENDOR IDENTIFICATION NUMBER | | |

|(MANDATORY FOR TRAVEL REIMBURSEMENT) | | |

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|TRAINING OFFICER: |EMPLOYEE STATUS: ( x ) GDC ( ) MCG ( ) Contract |

| |( ) Volunteer/Intern ( ) Other ( ) Other State |

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|OFFICIAL JOB TITLE: |OFFICE TELEPHONE: |DATE OF APPLICATION: |RACE: |GENDER: |

| |( ) - | | |( ) M ( ) |

| |CELL NUMBER: | | |F |

| |( ) - | | | |

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|COURSE INFORMATION |Have you completed BCOT or BPOT: ( ) Yes ( ) No |

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|TITLE: |SUPERVISOR |

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|DATE (First Choice): |DATE (Second Choice): |( ) APPROVED ( ) DISAPPROVED |

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|LOCATION: |PRIORITY RANK: ( ) 1 ( ) 2 ( ) 3 |

| |( ) 4 ( ) 5 ( ) 6 |

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|TRAINING SOURCE (GDC Calendar, GPSTC Calendar, Etc.) |AUTHORIZING AUTHORITY SIGNATURES |

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|DO YOU REQUIRE ACCESSIBILITY ASSISTANCE? |SUPERVISOR: |

|( ) YES ( ) NO | |

|(If yes, please complete back of application) | |

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|TO BE COMPLETED BY PRISON TRAINER/CHIEF PROBATION OFFICER/SUPERINTENDENT/WARDEN |MH/MR DIRECTOR/ HEALTH SERVICES ADMINISTRATOR: |

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|( ) COMMUTER ( ) DESIGNATED DRIVER | |

| |NOTE: Mental Health/Health Services Training only when applicable. |

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|REQUESTED LODGING DATES : |WARDEN/SUPERINTENDENT/DISTRICT/REGIONAL DIRECTOR: |

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|FOR OFFICE USE ONLY | |

|PROGRAM CANCELED: _______________________ | |

|PROGRAM FILLED: ______________________ |DIVISION DIRECTOR: |

|PROGRAM CONFIRMED: _______________________ | |

|PROGRAM WAITING LIST: _______________________ | |

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| |NOTE: Management in State Government Series Only |

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