Officer Application

Answer each question clearly and completely.
Make sure to have all required fields filled out before submitting your application. Required fields are marked with an asterisk *.

Today's Date:*
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Last Name:*
First Name:*
Middle:
Driver License Number:*
Height:*
Weight:*
Hair Color:*
Eye Color:*
Marital Status:*
Address:*
Social Security Number:*
Birth Date:*
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Home Phone:
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Cell Phone:*
-
E-mail:
List any other name(s) you may have been known by:
List any other Social Security number you have used:
Are you over the age of 21?:*
Are you CLEET Certified?:*
Date of Certification?:
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Have you ever applied with this Police Department before?:*
If yes, when?:
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EDUCATION/TRAINING

High School Attended:*
High School Location/City and State:*
Year Graduated:*
College 1 Attended/Further Education:
College 1 Location/City and State:
College 1 Degree/Hours Completed:
College 2 Attended/Further Education:
College 2 Location/City and State:
College 2 Degree/Hours Completed:
Have you worked for another Police Agency?:*
If Yes, which Agency?:
And current status with said Agency:
List Law Enforcement Training and/or Experience:*
Have you served in any Branch of the Military?:*
If Yes, Indicate which Branch:
And current status with said Branch:
List Military training/or experience that would assist you in being a Police Officer:

General Information

Current or last Employer:*
Position Held:*
Dates Employed:*
Business Phone:*
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2. Previous Employer:
2. Position Held:
2. Dates Employed:
2. Business Phone:
-
3. Previous Employer:
3. Position Held:
3. Dates Employed:
3. Business Phone:
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Have you ever been fired, suspended, or put on an inactive status (other than for workers compensation cases) by any of your previous employers?:*
If yes, state circumstances:

Residence: List previous places for the past 3 years

Address 1:*
Address 2:

Criminal Record (Criminal History Background Check will be performed on all Applicants)

Law Enforcement personnel must have a clean conviction record and no be addicted to controlled substances. (Arrest information will not necessarily disqualify you).

As an Adult have you been Arrested?:*
Placed in Jail?:*
Detained?:*
Recieved a Conviction?:*
Suspended Sentence?:*
Deferred which was not expunged or sealed?:*
Probation?:*
By any court of law or enforcement body anywhere?:*

If so, please explain below:

Explain:
Record Date 1:
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Charges 1:
Age 1:
Court of Jurisdiction 1:
Disposition 1:
Police Agency Involved 1:
Record Date 2:
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Charges 2:
Age 2:
Court of Jurisdiction 2:
Disposition 2:
Police Agency Involved 2:
Other explanantion :
Position your applying for?:*
Explain in detail why you want to be a Police Officer:*

References

Reference Name:
Phone Number:
-
Your relationship to this person:
Their work position:
Reference Name:(1)
Phone Number:(1)
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Your relationship to this person:(1)
Their work position:(1)
Reference Name:(2)
Phone Number:(2)
-
Your relationship to this person:(2)
Their work position:(2)
TYPE YOUR NAME TO SUBMIT AS A DIGITAL SIGNATURE:*
SIGNED UNDER PENALTY OF PERJURY ON THIS DATE:*
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Word Verification:

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Your application will be on file for 6 months, you may reapply after this time period.