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Hr 218 qualification form 2026
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- Click ‘Get Form’ to open the hr 218 qualification form in the editor.
- Begin by entering your personal information. Fill in your First Name, Middle Initial, Last Name, Address, City, State, Zip Code, Phone Number, Social Security Number, Date of Birth, and FOP ID #.
- Indicate your Employment Status by selecting either 'Active' or 'Retired'.
- If you are paying by credit card, complete the payment section with your Card Holder Name, Card Number, and Expiration Date. Ensure to check the box for automatic renewal if applicable.
- Review all entered information for accuracy. Incomplete or incorrect forms may lead to ineligibility for benefits.
- Finally, sign the form at the designated area to certify that you meet all requirements set forth in LEOSA.
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hr 218 application
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