ATF Adjunct Instructor Data Form

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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 ATF Adjunct Instructor is anyone who is not an ATF employee and provides unpaid instructor services for ATF. Adjunct instructors may be anyone from another,
Federal, State or local government agency, the military, educational institution, trade organization, or a subject matter expert (SME) who is not being compensated through
contract. Note that the reimbursement of travel expenses to persons who do not meet the definition above will be considered contract instructors and should not
complete this form (see exception in the note section below). All persons interested in becoming an ATF Adjunct Instructor must complete this form in its entirety, to include
the Hold Harmless Agreement on Page 6. The instructor candidate must forward the properly completed form and Hold Harmless Agreement via email through two (2)
levels of ATF supervisory approval from supervisors within the ATF program office responsible for the training. The two-levels of approval that will be accepted must consist
of a Branch and Division Chief; an Area Supervisor and Director of Industry Operations; a Group Supervisor and Assistant Special Agent in Charge; or any ATF employee
temporarily and formally named to serve in one of these titled positions. Adjunct instructor candidates may not (1) be prohibited from the receipt, possession, or transportation of firearms, explosives, or ammunition; or (2) have failed any course that the candidate will or is being considered to instruct.
ATF supervisors approving the instructor candidate’s use in ATF training programs are responsible for (1) verifying the candidate has properly completed this form, (2)
determining that all eligibility requirements are met, and (3) ensuring the candidate possesses all subject matter expertise (SME) and instructional skills required. After two
levels of supervisory approval are received, the second-level supervisor must email the completed form to the ATF Instructor mailbox in Outlook for final review by the ATF
Human Resources and Professional Development, Leadership and Professional Development Division and entry into the Justice Talent Management System (JTMS)
instructor database. The email’s subject line should include the candidate’s last name. The candidate may not be used in ATF training programs until the
candidate is entered into JTMS instructor database and such entry has been communicated. Any questions relative to the completion of this form should also be submitted to
the ATF Instructor mailbox in Outlook.
EXCEPTIONS: Contract instructors are not to complete this form unless the instructor services are being provided through a company, corporate, or organizational
contract, or a small purchase order that does not specifically identify the names or subject matter expertise of the instructors to be used. On these occasions, a copy of the
contract or small purchase order should be attached to this form.

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**All sections of this form must be completed. If any section of this form does not apply, please record “NA”**

Instructor Information

2. Address:

1. Name:

4. Current Employer & Address:

5. Current Position and Years Held:

7. Mobile Phone Number:

8. E-mail Address:

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6. Office Phone Number:

3. Date:

D

9. Job-Related/Specialized Experience (if additional space is needed, please attach a separate sheet)
Employer Name, Address & Phone Number
Position Title & Dates Held
Specialized Experience

Page 1 of 6

ATF Form 6140.3
Revised ( )

10. Formal Instructor Training Received:

Yes

No

Training Provider:
Course Title:
Completion Date:

11. Degrees Held From Accredited Institutions:
Training Provider

Degree Type

Completion Date

12. Other Certifications Held:
Subject Matter

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Certificate Title

Completion Date

13. Other Applicable Formal Training:

Educational Institution

R

Program or Training Course

Completion Date

14. Formal Training Course Previously Delivered:
Audience

Completion Date

D

Course Title/Topic

15. Subject Matter Expertise:
Please check the boxes that identify your expertise. For any subject expertise that is not listed below, please record them in Item 16.
Administration

N/A

Acquisition Management

OPSEC / Physical Security

ATF Budget Processes

ATF Peer Support Program

Conduct and Accountability

ATF Mentoring

Contracting Officers Technical Representativen (COTR)

Project Management

Employee Benefits

Purchase Card Reconciliation

Hiring Practices

ATF Sexual Harassment Policy and Procedures

Human Resources Management

Statistical Analysis

ATF Academy Physical Fitness Program (Physical Efficient Battery)

Strategic Planning & Performance Management Development

Page 2 of 6

ATF Form 6140.3
Revised ( )

N/A

Alcohol and Tobacco
Alcohol Diversion Techniques

Tobacco Diversion Techniques

Alcohol Laws and Regulations

Tobacco Laws and Regulations
Arson

Certified Fire Investigator

Fire Cause and Origin

Basic Arson Investigation Techniques

Fire Protection Engineer

Arsonist Psychology and Behavior

HAZMAT/OSHA

Arson Laws

Insurance Data Source

N/A

N/A

ATF Emergency Medical Technician (EMT)
EMT Basic

EMT Paramedic

EMT Intermediate

EMT CPR Instructor

EMT Dive

EMT AED Instructor

EMT Special Response Team
Canine
SRT Tactical Canine Handler

Explosives Investigation Canine Handler

Canine Facility Instructor

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Arson Investigation Canine Handler

N/A

N/A

Computer Systems

Computer Incident Response

Certified N-Force Instructor

IT Contingency Planning

Certified N-Spect Instructor

IT Security

Certified Spartan Instructor
Learning Management System / JTMS

Digital Forensics / Analysis

Criminal Organization Investigation

Violent Anti-Government Groups

Complex Conspiracy Cases

R

Adult and Youth Gangs
Outlaw Motorcycle Gangs

N/A

Terrorist Groups

D

Explosives

N/A

Certified Explosives Specialist

Post-Blast Investigation Techniques

Explosives Enforcement Officer

Identification & Development of Improvised Explosive Devices

Explosives Related Electronics

Identification & Development of Improvised Explosive Materials

Explosives / Pyrotechnics Chemistry and Theory

Illegal Fireworks Investigations

Explosives Handling

Explosives Disposal

Explosives Storage Regulation and Inspection

Explosives Laws & Regulations
Firearms

Firearms Technology & Manufacture

Serial Number Restoration

Establishing Interstate Nexus

NIBIN Program

Firearms Investigation Techniques

ATF-Certified Firearms Range Instructor

Firearms Application/Compliance Inspection Requirements and Procedures

FLETC-Certified Firearms Range Instructor

Firearms Laws and Regulations

Firearms Smuggling

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N/A

ATF Form 6140.3
Revised (
)

Field Operations
Operational Planning

IOI Hearing Officer

Electronic Surveillance Techniques and Equipment

Report Writing

Undercover Investigation Techniques

Asset Forfeiture

Home Invasions

Auditor Services

Interviewing Techniques

Money Laundering

Behavioral Science

Investigative Research Techniques

Victim/Witness Program and Contact Policy

Investigative Information Analysis Techniques

Post-Incident Shooting Review

Financial Investigation Techniques

Forensic Photography

Case Management

Agent Cashier

G.R.E.A.T. Instructor
Intelligence

Intelligence Methodologies and Research

Crime Gun Intelligence/CGIC

Advanced Intelligence Techniques

Certified Analyst Notebook Instructor

Intelligence Analytic Techniques

Certified Penlink Instructor

N/A

N/A

Intelligence Data Sources

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Laboratory Services

Arson Laboratory Services, Processes, and Policies

Trace Evidence Analysis

Explosives Laboratory Services, Processes, and Policies

Toolmark Examination

Firearms Laboratory Services, Processes, and Policies

NIBIN Correlatioin

Languages

Portuguese

Farsi

R

French
German

Mandarin

D

Hindi
Italian

Romanian

Russian
Spanish
Serbian
Thai
Turkish

Leadership

Supervisory Policy and Procedure

Employee Coaching Skills

Supervisory Interviewing Skills

Employee Counseling

Labor and Employee Relations

EEO Counseling
Legal Services (for Attorneys Only)

Administrative Law

Domestic Violence Offenses

Courtroom Procedures

Undercover Operations Law

Ethics and Integrity

Surveillance Operations Law

IOI Informal Firearms Hearing Procedures

Electronic Surveillance Law

Search Warrant Development

Intelligence Operations Law

Search Warrant Affidavit Preparation

Cybercrime / Internet Law

Page 4 of 6

N/A

Polish

Arabic

Hungarian

N/A

N/A

N/A

ATF Form 6140.3
Revised ( )

Response Teams

N/A

Special Response Team

Critical Incident Management Response Team

National Response Team

Crisis Negotiator
Use of Force/Personal Protection

Use of Force Continuum

Containment and Arrest Technique (CATs)

Non-Lethal/Unarmed Self Defense Techniques (Certified by
non-ATF certifying body)
Non-Lethal/Unarmed Self Defense Techniques (Certified by ATF)

Simunitions Use and Certification

Certified Spontaneous Knife Defense Instructor

N/A

Certified OC Spray Instructor
Certified OC Spray Instructor Trainer
Certified Defense Tactics Instructor

Certified Spontaneous Knife Defense Instructor Trainer

Certified Defense Tactics Instructor Trainer

TASER Instructor
TASER Instructor Trainer

Training and Instruction
Instructional Theories and Techniques

Training Assessment and Analysis

Instructional Systems Design

Curriculum Development

N/A

16. Please list any other Subject Matter Expertise or specialty skills or knowledge that you hold that are not listed in Item 15 above:
Description

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Other SME or Specialty Skill

Training Provider

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17. Please list any other certifications that you hold that are not previously listed:

Completion Date

D

Type

18. If you have participated as a member in any specialized units other than the teams listed in Item 15, please identify the unit and describe your role
(i.e. JTTF, VIP Protection Details, CEX-C, etc.)
Name of Unit

Page 5 of 6

Role

Dates Held

ATF Form 6140.3
Revised (
)

Adjunct Instructor 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.
Adjunct Instructor Candidate Certification
I understand and agree to the terms and standards of the above Adjunct Instructor Hold Harmless Agreement. I also certify that:
The information contained in this form is true and correct;
I am not prohibited from the receipt, possession, or transportation of firearms, explosives, or ammunition; and
I have not failed any course that I will or am being designated to instruct.

Adjunct Instructor Candidate Signature

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•
•
•

Adjunct Instructor Candidate Printed Name

Date

ATF Program Training Office Supervisory Approval

First-level Approving Authority
I have reviewed, verified, and support the information contained in this candidate’s form, and approve the named candidate for use in ATF training.
ATF First-level Approval Signature

Date

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ATF First-level Approver’s Printed Name

D

Second-level Approving Authority
I have reviewed, verified, and support the information contained in this candidate’s form, and approve the named candidate for use in ATF training.

ATF Second-level Approval Signature

ATF Second-level Approver’s Printed Name

Date

**The ATF second-level supervisor must submit the approved form to the ATF Instructor mailbox in Outlook.**
**The subject of the email must contain the last name of the candidate.**
1.

Privacy Act Information
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 ( )