Career Development Institute

Animal Cruelty Investigators Course

August 10-18, 2009
Camden County Police Academy

Career Development Institute

PO Box 5024

Kendall Park, NJ 08824

732-821-6997 (phone)

732-821-1514 (fax)

careerdevelopment@comcast.net (email)

www.careerdevelopmentinstitute.org (website)

Animal Cruelty Investigators Course Registration Form

APPLICANT INFORMATION (Please type or print clearly using black ink)
LAST NAME		FIRST		MIDDLE INITIAL
HOME ADDRESS				HOME TELEPHONE NO. ( )
CITY	STATE		ZIP CODE	CELL TELEPHONE NO. ( )
APPLICANT’S EMAIL ADDRESS

1. Are you a Certified Animal Control Officer? _______Yes ________No License #_________

2. What is your length of employment as a Certified Animal Control Officer? _________Years

3. Will you be appointed to the position of Animal Cruelty Investigator under N.J.S.A. 4:19-15.16 (b)

______Yes ______ No

Applicant Signature____________________________ Date__________________

Please return this form to the above address with a check or purchase order payable to

Career Development Institute in the amount of $689 which covers tuition and materials for this course.