FORM B (RENEWAL APPLICATION) 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