Application for Police Officer

We consider applications for all positions without regard to race, color, religion, creed, sex, national origin, disability, sexual orientation, citizenship status or any other legally protected status.

What is your current employment status?

Employed

Self-Employed

Unemployed

Student

Are you available to work

Full Time ( any shift/time)

Part Time

Temporary

Restricted Schedule

Available start date

YYYY

Desired Salary Range?

Name

Social Security Number (Voluntary)

Date of birth

YYYY

Address

Phone

Best time to contact you at home is:

Are you at Least 21 years of age but lest than 46 years of age?

YES

Are you a citizen of the United States ?

YES

Do you have a valid Driver's License ?

YES

Are you willing to submit to psychological testing (MMPI, CPI, psychological interview) ?

YES

Do you have a high school diploma or G.E.D ?

YES

Have you, or will you receive a discharge from Military duty under honorable conditions? (Honorable, General, Etc.) ?

YES

N/A

Do you have any felony convictions ?

YES

Have you been convicted of driving while your license was suspended within the last five (5) years ?

YES

Have you been convicted for driving under the Influence of alcohol or drugs within the last ten (10) years ?

YES

Have you used marijuana within the last five (5) Years ?

YES

Have you used any other illegal drug(s) within the last five (5) years ?

YES

If yes, what drug(s)

Have you ever files an application with us before?

YES

Have you ever been employed with us before?

YES

If yes, give date

YYYY

May we contact your present employer?

YES

Are you prevented from lawfully becoming employed in this country because of visa or immigration status (proof of citizenship or immigration status will be required upon employment)

YES

Are you currently on Lay off status and subject to recall?

YES

Can you travel if job requires it?

YES

Are you CLEET Certified?

YES

Education

High School (Name, Address, Course of Study, Number of years completed)

College (Name, Address, Course of Study, Number of years completed, Diploma/Degree)

Law Enforcement Training (Name, Address, Course of Study, Number of years completed, Diploma/Degree)

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

Describe any job related training received in United States Military.

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer 1

Dates Employed

Hourly Rate/Salary

Address

Phone

Job Title

Duties

Supervisor

Reason for Leaving

Employer 2

Dates Employed

Hourly Rate/Salary

Address

Phone

Job Title

Duties

Supervisor

Reason for Leaving

Employer 3

Dates Employed

Hourly Rate/Salary

Address

Phone

Job Title

Duties

Supervisor

Reason for Leaving

Employer 4

Dates Employed

Hourly Rate/Salary

Address

Phone

Job Title

Duties

Supervisor

Reason for Leaving

Would you like to list references?

Yes

Name

Phone

Name

Phone

Name

Phone

List all other qualifications, experience, certifications you feel may be helpful to us in considering your application.

Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation? ( Only answer question after being informed about the requirements of the job for which you have applied)

Yes

I certify that answers given herein are true and complete.
I authorize investigation of all statements contained in this application for employment as may be
necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 45
days. Any applicant wishing to be considered for employment beyond this time period should
inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any
employment relationship with this organization is of an "at will" nature, which means that the
Employee may resign at any time and the Employer may discharge Employee at any time with or
without cause. It is further understood that this "at will" employment relationship may not be
changed by any written document or by conduct unless such change is specifically acknowledged in
writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my
application or interview(s) may result in discharge. I understand, also, that I am required to abide
by all rules and regulations of the employer.

Electronic signature