FORM A (NEW APPLICATION) As a new applicant to IROCC, this form will need to be completed in full, printed, signed by participant and participant's department representative and mailed to IROCC along with any requested documentation and a check or money order. Concealed Carry Affidavit Default Page Before Retirement/Separation (Choose One) Was Employed as a Law Enforcement Officer for ten (10) or more years aggregateSeparated from service as a law enforcement officer after completing applicable probationary period due to service connected disability as determined by the department/agency. Please Answer All Questions I retired for reasons related to mental health. YesNo I affirm I met the State of Illinois’ definition of "law enforcement officer," as defined in 20 Ill. Adm. Code 1720.220. YesNo I was authorized to engage in or supervise the prevention, detection, investigation, prosecution or incarceration of any person for, any violation of law, and I had statutory powers of arrest. (Military Applicants: apprehension authority under section 807(b) of title 10, United States Code [article 7(b) of the Uniform of Military Justice]). YesNo I affirm I will not carry a firearm while I am under the influence of alcohol or another intoxicating or hallucinatory drug or substance. YesNo I affirm that I am not prohibited by Federal or State law from receiving a firearm. YesNo I understand that the definition of "firearm" does not include any machine gun, firearms silencer, or destructive device, and understand this authorization applies only to the firearm type with which I qualified. YesNo I understand that I must meet the same State of Illinois’ standards of requalification for active law enforcement officers to carry a firearm of the same type with which I qualified. YesNo I understand that my permit has an expiration date and it is my responsibility to reapply if I wish to continue to carry under this law. YesNo I understand that I must carry the State of Illinois’ retired officer concealed carry firearm qualification card, along with the photographic identification issued by my agency and valid Illinois F.O.I.D. card when I carry a concealed firearm. YesNo I understand that a background investigation is required and do authorize one to be conducted to determine if I have been convicted of any criminal offenses or have any mental health issues that would disqualify me from possessing a concealed firearm. YesNo I understand that the State of Illinois’ firearm qualification card does not give me any right whatsoever to exercise law enforcement authority or take police action under any circumstances. YesNo I affirm I have not been charged with or convicted of a felony or misdemeanor specified in the Police Training Act section on decertification of police officer 50 ILCS 705/6.1 or any similar offenses in any other state. YesNo I understand that I must complete any course of instruction required by the Illinois Law Enforcement Training and Standards Board. YesNo I understand that I may be refused entry to a qualification facility by a Rangemaster if he or she believes that my physical condition is a safety hazard to myself or others. YesNo Please confirm before advancing I Confirm that I Am Applying for an IROCC Certification and am of sound body and mind