Professional Documents
Culture Documents
6 3 3 0 E . H i g h w a y 2 9 0 , S TE . 2 0 0
Au s t i n , Te x a s 7 8 7 2 3 - 1 0 3 5
Phone: (512) 936-7700
http://www.tcleose.state.tx.us
2. M.I.
3 . L a s t N am e
4 . S uf f i x ( J r . ,
etc.)
5. TCOLE PID
6. Date of Birth
8. City
7 . H om e o r P e r m a n e n t M a i l i n g A d d r e s s
9. State
1 1 . P h o n e N um b e r
1 2 . AP P O I N T M E N T ( s ) ( C h e c k a l l t h a t a p p l y)
Peace Officer
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Honorably Discharged
Retired, resigned, or separated from employment with or died while employed by a law enforcement agency while in good
standing and not because of pending or final disciplinary actions or a documented performance problem.
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General Discharge
(A) was terminated by, retired or resigned from, or died while in the employ of a law enforcement agency and the separation was
related to a disciplinary investigation of conduct that is not included in the definition of dishonorably discharged; or
(B) was terminated by or retired or resigned from a law enforcement agency and the separation was for a documented
performance problem and was not because of a reduction in workforce or an at-will employment decision.
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Dishonorably Discharged
(A) was terminated by a law enforcement agency or retired or resigned in lieu of termination by the agency in relation to
allegations of criminal misconduct; or
(B) was terminated by a law enforcement agency or retired or resigned in lieu of termination by the agency for insubordination or
untruthfulness.
ATTENTION LICENSEE:
If this is your second dishonorable discharge on an F-5 Report, your license will be suspended upon TCOLEs receipt of
this document. Failure to timely appeal a second dishonorable discharge with a Petition to Correct form will result in the
revocation of your license.
18. I, chief administrator or designees, attest that this is a true and accurate explanation of the circumstances
under which this person resigned or was terminated.
A c o p y o f t h i s F - 5 w a s p r o v i d e d t o t h e p e r s o n a s r e q u i r e d b y O c c u p a t i o n s C o d e 1 7 0 1 . 4 5 2 ( d ) , i n 7 b u s i n e s s d a ys
b y:
Date
Date
______________________________________________________________________________________________________________________
Signature
Date
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