Employment Desired
Full-Time Part-Time
Reserve
Date you can
start Salary Desired
Ever applied here before How did you learn about the opening
General Information
Name: Last
First Middle
Home phone
Cell phone
Address
City
State
Zip County
DL#
DL State
SS#
E-mail
List your last four previous addresses, and what dates you lived
there
Special Questions
Have you been convicted of a felony or a misdemeanor within
the past 5 years?
If so please describe
Are you 21 years or older Date of birth
Place
of birth
Are you prevented from lawfully becoming employed in the U.S.A
This information is required for a bona fide occupational qualification, or is dictated by national security laws, or is needed for
other legally permissible reasons. The age discrimination in employment act of 1967 prohibits discrimination on the basis of age
with respect to individuals who are at least 40 but less than 70 years of age. you will not be denied employment solely because
of a conviction record, unless the offense is related to the job for which you have applied.
Education
Did you graduate from highschool or receive a GED
Schools you have attended
Grade School Name
Address Phone
Did you graduate
High School Name
Address Phone
Did you graduate
College Name
Address
Phone Did you
graduate
Other Schooling
Address Phone
Employment History
Current employer Phone
Supervisor
Type of job
Address
Your job title
Dates employed (indicate months & years)
From
To
Average hours worked per week
Duties
Monthly Salary
Reason for leaving
Please list your past six jobs, (including all the information listed
above):
General
U.S. Military or Naval Service
Rank
Present membership in National Guard or Reserve
List and Licenses or Certification you have
List computer skills (Hardware and Software)
Other education/training/skills
Your Potential
1. Why do you want to become a police officer
2. What do you believe the role of a Police Officer involves?
3. As a Police Officer, what stressful situations do you think you may have to encounter?
How do you think you may deal with these?
4. What do you consider some of the current policing issues affecting the City Of
Udall might be?
5. What are some of the things you would do to improve the city and to encourage
community involvement.
References
GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM
YOU HAVE
KNOWN AT LEAST ONE YEAR.
1. Name
Address
Business Phone
Years Acquainted
2. Name
Address
Business Phone
Years Acquainted
3. Name
Address
Business Phone
Years Acquainted
Hobbies & Interests
Please describe your interests, activities & hobbies.
Physical Record
Do you have any physical
limitations that preclude you from performing any work for
which you are being considered?
if yes, what can be done to accommodate your limitation? Please
Describe:
Emergency Contacts
1. Name
Address Phone
2. Name
Address Phone
I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE
TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED
STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.
I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES
LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS
EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR
OTHERWISE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE
THAT MAY RESULT FROM FURNISHING SAME TO YOU.
I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE
PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND
SALARY, BE TERMINATED AT ANY TIME WITHOUT ANY PRIOR
NOTICE.
Date Full legal
name
