POST - Employment Record

Agency Information

Agency ORI*

Agency Name*

Agency CEO*

Address Line 1*

Address Line 2

City*

Zip*

Phone*

Fax

Agency Email

Your Name*

Your Email*

Officer Information

Officer First Name*

Officer Middle Name

Officer Last Name*

Peace Officer License #*

Last 4 SSN*

Address Line 1*

Address Line 2

City*

State*

Zip*

Phone*

DOB*

mm/dd/yyyy

Gender*

Officer Status

Notification Reason*

If you have any questions about the submission of this form, please contact the POST program at 573-526-2764 or email cheryl.parris@dps.mo.gov.
A PRINT link will be available on the success page, after the form is submitted.