Get PA SP 8-200B 2021-2024

HE/SHE MAY BE REQUIRED TO EXERCISE PHYSICAL CONTROL IN A SITUATION OF HIGH PSYCHOLOGICAL AND EMOTIONAL STRESS AS AN ACT 235 AGENT. LAST NAME FIRST NAME STREET ADDRESS MIDDLE INITIAL CITY/BORO SOCIAL SECURITY NUMBER DATE OF BIRTH STATE GENDER ZIP CODE DATE OF EXAM INTERVIEW AND HISTORY The psychologist must individually interview the applicant and attach a separate typed record of the individual interview that addresses at a minimum each of the areas below. NOTICE AND INSTRUCTIONS TO EXAMINING PSYCHOLOGIST THIS EXAMINATION MUST BE ADMINISTERED BY A LICENSED PSYCHOLOGIST WHO IS LICENSED BY THE PENNSYLVANIA STATE BOARD OF PSYCHOLOGIST EXAMINERS. THIS EXAMINATION IS TO DETERMINE THE PSYCHOLOGICAL FITNESS OF THE APPLICANT TO APPROPRIATELY HANDLE A LETHAL WEAPON. A LETHAL WEAPON IS ANY FIREARM NIGHTSTICK BILLY CLUB OR OTHER WEAPON CALCULATED TO PRODUCE SERIOUS BODILY HARM OR DEATH. THE APPLICANT WHO YOU ARE ABOUT TO EXAMINE IS APPLYING FOR CERTIFICATION AS A PRIVATELY EMPLOYED AGENT WHO WILL BE VESTED WITH A POSITION OF PUBLIC/PRIVATE TRUST. HE/SHE MAY BE REQUIRED TO EXERCISE PHYSICAL CONTROL IN A SITUATION OF HIGH PSYCHOLOGICAL AND EMOTIONAL STRESS AS AN ACT 235 AGENT. SP 8-200B 6/2018 SUPERCEDES ALL PREVIOUS VERSIONS PENNSYLVANIA STATE POLICE LETHAL WEAPONS TRAINING ACT 8002 Bretz Drive Harrisburg Pennsylvania 17112-9748 www. lethalweapons. state. pa*us PSYCHOLOGICAL EXAMINATION This form is to be used by applicants seeking certification under the Lethal Weapons Training Act. NOTICE AND INSTRUCTIONS TO EXAMINING PSYCHOLOGIST THIS EXAMINATION MUST BE ADMINISTERED BY A LICENSED PSYCHOLOGIST WHO IS LICENSED BY THE PENNSYLVANIA STATE BOARD OF PSYCHOLOGIST EXAMINERS* THIS EXAMINATION IS TO DETERMINE THE PSYCHOLOGICAL FITNESS OF THE APPLICANT TO APPROPRIATELY HANDLE A LETHAL WEAPON* A LETHAL WEAPON IS ANY FIREARM NIGHTSTICK BILLY CLUB OR OTHER WEAPON CALCULATED TO PRODUCE SERIOUS BODILY HARM OR DEATH. THE APPLICANT WHO YOU ARE ABOUT TO EXAMINE IS APPLYING FOR CERTIFICATION AS A PRIVATELY EMPLOYED AGENT WHO WILL BE VESTED WITH A POSITION OF PUBLIC/PRIVATE TRUST. HE/SHE MAY BE REQUIRED TO EXERCISE PHYSICAL CONTROL IN A SITUATION OF HIGH PSYCHOLOGICAL AND EMOTIONAL STRESS AS AN ACT 235 AGENT. LAST NAME FIRST NAME STREET ADDRESS MIDDLE INITIAL CITY/BORO SOCIAL SECURITY NUMBER DATE OF BIRTH STATE GENDER ZIP CODE DATE OF EXAM INTERVIEW AND HISTORY The psychologist must individually interview the applicant and attach a separate typed record of the individual interview that addresses at a minimum each of the areas below. Provide details and explanations of any positive findings of criminal and/or psychological history. -PERSONAL EDUCATIONAL AND EMPLOYMENT HISTORIES -MENTAL HEALTH STATUS AND HISTORY CURRENT AND/OR PAST COUNSELING DIAGNOSES PSYCHOTROPIC MEDICATION USE PSYCHIATRIC HOSPITALIZATION IN SPECIALTY OR GENERAL HOSPITAL ETC. -CRIMINAL HISTORY TO INCLUDE ARREST HISTORY INCLUDING ANY ARD OR EXPUNGED DISPOSITIONS Failure to address all required topics will result in the return of the documentation for more information* MMPI-2 PERSONALITY TEST ALL SCALES REQUIRED Required Personality Test The applicant shall be administered any full length current standard form of the Minnesota Multiphasic Personality Inventory MMPI-2 or MMPI2-RF by the licensed psychologist or paraprofessional employed by and under the direct control and supervision of the licensed psychologist.