NOTE TO APPLICANT:

PLEASE ENSURE ALL AREAS ARE FULLY COMPLETED


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Referenced from: Police Science (Cadet)

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NOTE TO APPLICANT:

PLEASE ENSURE ALL AREAS ARE FULLY COMPLETED
All expenses relating to this examination are the responsibility of the applicant.
Submit completed form with your application.

LAST NAME

GIVEN NAMES

DATE OF BIRTH

ADDRESS

PHONE NUMBER

VISION STANDARDS FOR APPLICANTS

Complete A or B and C, D, E & F:

A. Minimum visual acuity for those not requiring visual aid:
◆ Uncorrected:

Must be 6/6 (20/20) in one eye and at least 6/9 (20/30) in the other.

Passed
Failed
B. Minimum visual acuity for those requiring visual aid: (This minimum vision acuity is required for safe performance of policing duties if glasses or contacts are lost or displaced.)
◆
Uncorrected: (without glasses or contacts lenses)

Must be at least 6/18 (20/60) in each eye, or at least 6/12 (20/40) in one eye & 6/30 (20/100) in the other.

Passed
Failed
◆ Corrected:

(with glasses or contacts lenses)

Must be 6/6 (20/20) in one eye and at least 6/9 (20/30) in the other.

Passed

Failed

C. Field of Vision:

Must be at least 150 degrees continuous along the horizontal meridian and 20 degrees continuous above and below fixation with both eyes open and examined together.

Passed
Failed
D. Depth Perception:

Normal stereo vision (use of both eyes to judge distances) must be present. Stereo acuity must be a minimum of 70 seconds of arc or better on Titmus test.

Passed
Failed
E. Color Vision:

Ishihara Test. If Ishihara test is failed, must pass Farnsworth D-15 Test.

Passed
Failed
F. Binocular Vision:

Normal

Passed
Failed

Applicants who have had laser eye surgery must meet the above visual standards.

2 . APPLICANT’S DECLARATION:

I declare that the statements made to the ophthalmologist/optometrist are complete and correct to the best of my knowledge and that I have not withheld any relevant information or made any misleading statements. I understand that some employers may have vision standards different than the above and that meeting the above standards on this date does not guarantee my vision will meet the requirements of all employers.

Applicant’s signature

(in the presence of the examiner):

Date:

OPHTHALMOLOGIST/OPTOMETRIST

Name:

Business Address:

Signature:

Date:

The personal information requested on this form is collected under the authority of Section 31(c) of the PEI Freedom of Information and Protection of Privacy Act and will be protected under Part 2 of that Act. It will be used to assess visual acuity of applicants to the Police Science (cadet) program. If you have any questions about the collection or use of this information, please contact the Chief Privacy Officer at privacy@hollandcollege.com or 902-566-9542, 140 Weymouth St., Charlottetown, PE, C1A 4Z1.

VISUAL EXAMINATION FORM

POLICE SCIENCE (CADET) PROGRAM REQUIREMENTS

Source: https://sam.hollandcollege.com/shared/QMS/Forms/QF151-200/QF190-APAVisualExamForm.pdf