Form ATF F 6140.3 ATF F 6140.3 ATF Adjunct Instructor Data Form

OMB No. 1140-0099 (xx/xx/xxxx)

U.S. Department of Justice
Bureau of Alcohol, Tobacco, Firearms and Explosives

ATF Adjunct Instructor Data Form

An Adjunct Instructor is anyone who is not an ATF employee and provides unpaid instructor services for the Office of Human Resource and Professional Development (HRPD). Adjunction Instructors may be anyone from another Federal agency, military, State or local government, educational
institution, trade organization, or a subject matter expert that is not being compensated through contract. All Adjunct Instructors utilized by the HRPD
must complete and forward this application through the Branch/Division Chief responsible for the training. In order to be accepted, the Hold Harmless
Agreement on the data form must be signed by the adjunct instructor being considered.
Branch/Division Chiefs will be responsible for determining if the instructor applicant is qualified for use within their programs before forwarding the
application. Once signed, the adjunct instructor data form is to be forwarded to the Chief, Professional/Technical Training and Development Branch
(PTTDB) for review and processing. For questions, contact the Learning Management Branch (202) 648-8386.
Note: If instructors are providing services through an individual contract instrument such as a blanket purchase agreement or a sole source contract,
then their professional information has already been provided through their proposal and this form does not need to be completed. However, if
instructor services are being provided through a company contract that does not specifically provide expertise information of individual instructors for
TPD approval or if contract instructors are being acquired through a small purchase order, then this form must be completed for each instructor used in
training.
Contact Information
2. Address:

1. Name:

3. Office or Home Phone Number:

4. Cell Phone/Pager:

5. E-Mail Address:

6. Expertise Related Job Experience
Position Title

Employer

Address and Phone

Dates of Employment

Instructor Training
7. Have you attended formal instructor training?

Yes

No

If yes, please list the training provider and the date of completion:
Training Provider

Date of Completion

8. Please list any other relevant instructor training experience:

Page 1 of 6

ATF Form 6140.3
Revised (
)

Certifications Held
Type

Date

Certification

Applicable Degrees Held From Accredited Institutions
Degree and Program Title

Date Completed

University

Other Applicable Formal Training Attended
Course Title

Topic

Completion Date

Course Provider

Please place an “X” next to all areas of expertise, specialty, or certification. For anything that does not appear in the areas provided, there is an “Other”
category in the last table where you may add your expertise or specialty area.
Alcohol and Tobacco
Alcohol Diversion Investigations

Tobacco Diversion Investigations
Arson

Basic Arson Investigation Techniques

Fire Cause and Origin

Arsonist Psychology and Behavior

Fire Protection Engineer

Certified Fire Investigator

Insurance Industry Data Sources

Financial Investigation Techniques

HAZMAT/OSHA

Arson Investigation Canine Handler

Canine
TPD Canine Facility Instructor

Explosives Investigation Canine Handler
Criminal Organization Investigation
Adult and Youth Gangs

Terrorist Groups

Complex Conspiracy Investigations

Violent Anti-government Groups

Outlaw Motorcycle Gangs
Emergency Medical Technician (EMT)
EMT Basic

EMT Paramedic

EMT Special Response Team

EMT CPR Instructor Trainer

EMT Dive

EMT AED Instructor Trainer

EMT Intermediate

Page 2 of 6

ATF Form 6140.3
Revised (
)

Explosives
Certified Explosives Specialist

Explosives/Pyrotechnics Chemistry and Theory

Explosives Investigation Techniques

Identification and Development of Improvised Explosive Devices

Explosives Disposal

Identification and Development of Improvised Explosive Materials

Explosives Enforcement Officer

Illegal Fireworks Factory Investigations

Explosives Handling

Post-blast Investigation Techniques

Explosives Related Electronics

Pyrotechnics Technician

Explosives Storage Regulation and Inspection

EPA Laws and Regulations
Firearms

Establishing Interstate Nexus

Firearms Technology and Manufacture

Firearms Application Inspection Requirements and Procedures

Firearms Trafficking Investigation Techniques

Firearms Compliance Inspection Requirements and Procedures

Serial Number Restoration

Firearms Investigation Techniques

Small Arms Smuggling

Firearms Regulation and Law

Toolmark Examination
General

ATF Peer Support Program

Contracting Officer’s Technical Representative (COTR)

ATF Sexual Harassment Policy and Procedure

Acquisitions Management

Business Case Development

ATF Budget Processes

Conduct and Accountability

Human Resource Management

Project Management

Purchase Card Reconciliation

Statistical Analysis

Employee Benefits

Strategic Planning and Performance Measure Development

Academy Physical Fitness Program (Physical Efficiency Battery)

Advanced Intelligence Techniques

Intelligence
Intelligence Analytic Techniques

Certified Analyst Notebook Instructor

Intelligence Data Sources

Certified Penlink Instructor

Intelligence Methodologies and Research

Arson Laboratory Services, Processes, and Policies
Explosives Laboratory Services, Processes, and Policies

Laboratory Services
Firearms Laboratory Services, Processes, and Policies
Trace Evidence Analysis
Languages (Able to Speak Fluently)

Arabic

Polish

Farsi

Portuguese

French

Romanian

German

Russian

Hindi

Spanish

Hungarian

Serbian

Italian

Thai

Mandarin

Turkish
Legal Services (for Attorneys Only)

Administrative Law

Integrity and Ethics

Alcohol/Tobacco Law and Regulation

Intelligence Operations Law

Arson Law and Regulation

Undercover Operations Law

Courtroom Procedures

Search Warrant Development

Electronic Surveillance Law

Search Warrant Affidavit Preparation

Explosives Law and Regulation

Informal Firearms Hearing Procedures

Firearms Law and Regulation

Domestic Violence Offenses

Page 3 of 6

ATF Form 6140.3
Revised (
)

Agent Cashier Requirements and Processes

Special Agent/Industry Operations Investigator
Auditor Services

Asset Forfeiture

IOI Hearing Officer

Electronic Surveillance Techniques and Equipment

Report Writing

Interviewing Techniques

IOI Inspection Techniques

Investigation Information Analysis Techniques

Behavioral Science

Investigative Research Techniques

Forensic Photography

Journeyman IOI Skills

Certified Respirator Fit Testing Instructor

Journeyman Special Agent Skills

Undercover Investigation Techniques

Money Laundering
Operational Planning
Training
Training Assessment and Analysis

Instructional Theory and Techniques
Instructional Systems Design

Use of Force/Personal Protection
Non-Lethal/Unarmed Self Defense Techniques (Certified by
non-ATF certifying body)
Non-Lethal/Unarmed Self Defense Techniques (Certified by ATF)
Certified Spontaneous Knife Defense Instructor
Certified Spontaneous Knife Defense Instructor Trainer

Certified OC Spray Instructor
Certified OC Spray Instructor Trainer
Certified Defensive Tactics Instructor
Certified Defensive Tactics Instructor Trainer
FLETC Certified Firearms Range Instructor

TASER Instructor
TASER Instructor Trainer
Use of Force Continuum

Simunitions Use and Certification
Containment and Arrest Techniques
Other

List Expertise/Specialty Area

Page 4 of 6

Description of Expertise/Specialty

ATF Form 6140.3
Revised (
)

Please Provide a Brief Biography Relating to Your Professional Experience and Expertise: (Special Agents interested in instructing Certified Explosives
Specialist or Certified Fire Investigator courses must attach a professional vitae to their e-mail application.)

Page 5 of 6

ATF Form 6140.3
Revised (
)

Hold Harmless Agreement
I,

, hold the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF), the Department of Justice, any
(Print Full Name)

organization providing training facilities and equipment on behalf of ATF, and its agents and employees harmless from liability for any injury suffered
by myself, my employer, my agents or employees while providing instruction for ATF managed courses. I will hold the same harmless for any damage
to any equipment or materials used or owned by myself, my employer, my agents or employees, except for those damages caused by the reckless or
wanton conduct of employees of ATF. Any damages to property, personal or otherwise, caused by myself, my employer, my agents or employees shall
be the responsibility of myself, my employer, my agents or employees, both jointly and severally.

My participation in ATF training creates no contractual or agency relationship between myself, my employer, my agents or employees; and ATF, the
Department of Justice, or any organization providing facilities and equipment on behalf of ATF, or its agents and employees.

Signature

Date
Branch/Division Chief Authorization

Branch/Division Chief
(Please Print Name)

Signature

Submitting Branch/Division

Date

Privacy Act Information
1. General: This information is provided pursuant to Public Law 93-579 (Privacy Act of 1974), December 31, 1974, relative to the collection of
information from prospective ATF instructors.
2. Authority: The Government Employees Training Act of 1958 (U.S. Code, Title 5 § 4101 to 4118), and 5 CFR § 410 to 412.
3. Purposes: The information requested will be utilized to determine the prospective instructor’s experience and qualifications, and whether he or she
meets the minimum requirements. The information is additionally utilized to provide a record of qualifications for courses taught by ATF and may
be used in litigation to illustrate the validity and effectiveness of training delivery.
4. Routine Use: ATF instructors are utilized to instruct a variety of ATF-sponsored training courses. ATF staff involved in the management, implementation, and evaluation of training will have access to these records in order to select appropriate instructors for identified training needs.
Records may be used in litigation to illustrate the validity and effectiveness of training delivery. Release of information to any other individual or
government official is on a need to know basis. Records are treated as sensitive personnel files and protected under the Privacy Act of 1974.
Disclosure of an individual’s personal data may be provided upon request to that individual with sufficient proof of identity.
5. Effects of Nondisclosure: Disclosure of this information is voluntary. Failure to provide this information, however, may result in ineligibility for
participation as an ATF instructor.
Paperwork Reduction Act Notice
This request is in accordance with the Paperwork Reduction Act of 1995. The information collection is used to determine the eligibility of the
applicant to attend ATF training.
The estimated average burden associated with this collection is 30 minutes per respondent depending on individual circumstances. Comments
concerning the accuracy of this burden estimate and suggestions for reducting this burden should be directed to the Reports Management Officer,
Document Services, Bureau of Alcohol, Tobacco, Firearms and Explosives, Washington, DC 20226.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB
control number.

Page 6 of 6

ATF Form 6140.3
Revised (
)