THOMAS J. DART SHERIFF OF COOK COUNTY

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1 THOMAS J. DART SHERIFF OF COOK COUNTY MEMORANDUM TO: FROM: SUBJECT: All Sheriffs Department Personnel Sheriff Thomas J. Dart Cook County Sheriffs Annual Physical Fitness Test 2013 DATE: 11 OCT 13 Please be advised the schedule for the Cook County Sheriff's Annual Physical Fitness Testing for all department personnel is as follows: Date: Time: Location: Sunday, 08 DEC hrs. or hrs. Moraine Valley Community College 9000 West College Parkway Palos Hills, Illinois Building A, Room I 04 The Cook County Sheriffs Annual Physical Fitness Test is a voluntary program. It is the participant's responsibilityto check with their physician or Health Care Provider for verification that he/she is physically capable of participating in this test prior to registration. Please be advised that any injuries incurred during or as a result of the voluntary performance of any required exercises will not be considered as an injury on dutv. Each participant who successfullycompletesthe Cook County Sheriffs Annual Physical Fitness Test will be awarded eight (8) compensatory hours. Retests will not be allowed to any member that fails any portion of the test. Any department member interested in participating in this test will be required to fax the Sign up Sheet to the Cook County Sheriff's Training Institute at (708) Times will be scheduled on first come basis. Final schedule will be posted on the website. Enclosed please find a sign up sheet, a Cook County Sheriff's Fitness Release ofliabilities Form and the Cook County Sheriff's Office Power Test Standards for those who wish to sign up for registration. Original forms must be brought on the testing date. Participants are required to bring two (2) forms of identification, a valid Driver's License or State I.D. and a Cook County Sheriff's I.D. Participants are also required to wear w<jkout clothing (sweat pants, sweat shirt and gym shoes). If you have any questions, please contact the Cook County Sheriff's Training Institute at (708) 9' PLEASE READ AT THREE CONSECUTIVE ROLL CALLS AND POST IN YOUR FACILITY.

2 COOK COUNTY SHERIFF'S TRAINING INSTITUTE FOR LAW ENFORCEMENT EDUCATION & TRAINING SHERIFF'S FITNESS AWARD P.O.W.E.R. TEST DECEMBER 8, 2013 Last Name Age D.O.B. First Name Male/Female Star Number JDE Number Department Division/Facility Weight (Calculated bv Academy Starn I.D. Card V erification --::---::-::-:=c-=--=::---::: Illinois P.O.W.E.R. Test Standards Test Men Women Age Group Sit and Reach Minute Sit-Up Max Bench Press % 98% 87% 79% 70% 58% 52% 49% 43% 1.5 Mile Run 13:46 14:31 15:24 16:21 16:21 16:52 17:53 18:44 Required Performed Pass/Fail Sit and Reach p F 1-Minute Sit-Up p F Bench Press p F 1.5 Mile Run D F This applicant understands that all scores are final and a retest will rot be allowed. Applicant's Signature I CertifY that no Political Reasons or Factors were considered in any decision I made or action I took related to this Emp~nt Action. Further, I do not know if, or have any reason to believe that anyone else considered or took action based on Political Reasons or Factors with respedthis Employment Action. Testing Instructor's Signature Star# Supervisor's Signature Star#

3 IN THE EVENT OF AN EMERGENCY, PLEASE CONTACT: NAME: RELATIONSHIP: ADDRESS: TELEPHONE: (DAY) (EVENING) I HAVE REVIEWED THE TEST REQUIREMENTS IN THE PHYSICAL ABILITY PACKET AND I UNDERSTAND THAT THE TEST REQUIRES A DEGREE OF PHYSICAL EXERTION, STRENGTH AND ABILITY. I AM PHYSICALLY ABLE TO PARTICIPATE IN THE PHYSICAL ABILITY TEST. I AGREE TO ASSUME ALL RISKS AND TO HOLD THE COOK COUNTY SHERIFF'S MERIT BOARD, THE COOK COUNTY SHERIFF'S PERSONNEL DEPARTMENT, MORAINE VALLEY COMMUNITY COLLEGE, THE COOK COUNTY SHERIFF'S TRAINING INSTITUTE AND ANY OF ITS EMPLOYEES AND AGENTS FREE FROM LIABILITY FOR ANY LOSS OR INJURY WHICH MAY RESULT FROM TAKING THIS PHYSICAL ABILITY TEST. PRJNTNAME SIGNATURE DATE TillS SECTION TO BE COMPLETED BY FAILED APPLICANTS ONLY: I CONCUR WITH THE F AlLURE REASON(S) INDICATED BY THE TESTING PERSONNEL. Applicant's Signature Date 2

4 COOK COUNTY SHERIFF'S INSTITUTEFoR LAW ENFORCEMENT EDUCATION & TRAINING THOMAS J. DART, SHERIFF SCOTT KURTOVICH, EXECUTIVE DIRECTOR SHERIFF'S POLICE ACADEMY TRAINING INSTITUTE DEPARTMENT OF CORRECTIONS ACADEMY COURT SERVICES ACADEMY Cook County Sheriff's Fitness Award Release of All Liabilities I (print name) the undersigned, recognizing that the Cook County Sheriffs Fitness Award Power Test is a voluntary activity, therefore my signature upon this document completely, absolutely and finally releases the County of Cook, Illinois, the Sheriff of Cook County, Moraine Valley Community College, the officers, agents, and employees thereof from any and all claims, demands and liabilities to me, my family or heirs as the direct or indirect result of any and all injuries, death losses and/or damage to my person or property that may arise as the result of the Cook County Sheriffs Fitness Award Power Test. I hereby affirm and declare that I have read all of the foregoing terms, conditions, and declarations and I fully understand and agree with them. In addition, I have reviewed the requirements of the Cook County Sheriffs Fitness Award Power Test and have discussed my physical ability to perform this test with my physician. After reading this release of all liabilities and reviewing the requirements with your physician, sign and date the form. Name: (Print)-----' Signature: '---- Date: MVCC, 9000 W. COLLEGE PKWY., BUILDING Al40, PALOS HILLS, IL TELEPHONE: (708) FAX: (708)

5 THOMAS J. DART SHERIFF OF COOK COUNTY 2013 ANNUAL PHYSICAL FITNESS AWARD TEST SIGN-UP SHEET NAME (Last, First) Star DEPARTMENT DIVISION/UNIT/ DATE OF JOE # {CS, DOC, CCSPD, DISTRICT BIRTH etc.) PHONE NO brs hrs... *ALL INFORMATION MUST BE COMPLETE BEFORE SENDING FORM TO THE SHERIFF'S TRAINING INSTITUTE*

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