Dear Prospective Police Candidate:

Size: px
Start display at page:

Download "Dear Prospective Police Candidate:"

Transcription

1 Dear Prospective Police Candidate: Thank you for your interest in a career with the Goose Creek Police Department. Upon submission, your application will be reviewed and considered along with other applications for the number of vacancies we must fill. As an equal opportunity employer, it is the policy of the Goose Creek Police Department to only hire qualified candidates who are best suited for employment with our agency without regard to race, sex, religious affiliation, or any other unlawful discriminator(s). It is impossible to project the probability that you will or will not be considered for employment; however, the following steps occur in the employment process: * Preliminary review of application packet (First by Human Resources to determine minimum qualifications and then by the Goose Creek Police Department if forwarded to the department by Human Resources.) * Preliminary background investigation to include at a minimum: Review of background supplement for disqualifying disclosures (see Police Officer M inimum Requirements and Restrictions on Page 2) Driver s license, criminal history (NCIC), and credit check Verification of prior employment, education, and experience * Standardized general knowledge written test * Interview with Chief of Police and command staff * Conditional offer of employment (employment contingent upon satisfactory polygraph examination and physical and mental fitness tests) * Interview with background investigator (may occur more than once) * Polygraph examination * Contacts with references and neighbors * Thorough investigation of any adverse disclosures or discoveries * Mental fitness examination (Conducted by a licensed clinical psychologist to identify disqualifying mental illness and ensure psychological suitability and emotional stability) * Physical examination and drug test (Conducted by a licensed physician to ensure physical suitability to perform the essential functions of law enforcement work) * Start date for employment upon final review of application packet by the Chief of Police with having successfully completed all previous steps There are no guarantees that any steps beyond preliminary review of your application packet will occur. From application to employment through all of the steps above can take from one to six months depending largely on the department s status of hiring, the scheduling of testing, and the applicant s particular background. You will be contacted personally by a background investigator if you are considered beyond preliminary review of your application. Otherwise, you will be notified in writing by the City s Human Resource Director or the hiring officer of the Goose Creek Police Department if you are not considered or disqualified. Please feel free to call me with any questions that you may have regarding our current status in hiring, anticipated vacancies, or the status of your application. In accordance with City policy, your application will remain active for six months unless you are rejected or disqualified. After six months, you must reapply if you wish further consideration. Best Wishes, Lieutenant Thomas Hill Office of Professional Standards

2 Police Officer Minimum Requirements & Restrictions To be considered for employment as a police officer, ALL applicants: Must be a United States citizen by birth or naturalization Must be 21 years of age Must be a high school graduate (diploma or GED) Must have a driver's license issued in the United States and be able to obtain a South Carolina driver's license if hired Must be of good moral character as demonstrated by past and present behaviors Must not possess racist or sexist ideologies Must not have engaged in acts of domestic violence even if no arrest was made Must not have engaged in habitual or serious criminal behavior, even if no arrest was made Must not have intentionally accessed internet sites for the purpose of viewing child pornography Must not have intentionally violated copyright or royalty provisions by downloading material from the internet Must not have used the anonymity of the internet to harass third parties Must have no criminal convictions Convictions for minor misdemeanors may be considered based on age at time of offense, time passed since offense, demonstrated behavior since offense, and agency demands. Must have a driving record that demonstrates consistent compliance with traffic laws No conviction for driving under the influence (DUI/DWI) within past 5 years No conviction for hit and run within past 5 years Driving under suspension (DUS) convictions are evaluated based on cause and timeframe No demonstrated pattern of willful disregard for traffic laws (gross violations or excessive accumulated violations) Must be free of illegal drug use and/or activity (no exceptions) Must not have bought, sold, transpo rted, manufactured, or ingested, heroin, LSD, nonprescribed, methamphetamine, or any other illegal substance within the past 10 years ( 5 years for cocaine and 2 years for marijuana and steroids) Must not have ingested controlled substances prescribed to another Must not have bought controlled substances prescribed for another for your own use or sold to another a controlled substances prescribed to you Must have demonstrated responsibility and integrity in personal financial affairs Must be current in financial obligations (consumer credit reports will be evaluated based on personal situations) Must not be in default on any student loan(s) Must be willing to fully disclose prior behaviors and submit to a polygraph examination conducted by a licensed examiner Must pass an entry level knowledge assessment test with a score of at least 80% Must be willing to submit to a medical examination conducted by a licensed physician if offered a position Must be willing to submit to a mental fitness examination conducted by a licensed psychologist if offered a position Must be willing to spend 12 weeks in Columbia, SC, at the South Carolina Criminal Justice Academy (SCCJA) to obtain certification if offered a position (non-sc certified applicants only) Must be willing to work rotating shifts (days, evenings, and nights), holidays, weekends, and in inclement weather Must be available for emergency recall in the event of a disaster or declared emergency Must not have experienced sustained misconduct while employed with other law enforcement agencies to include but not limited to (reviewed case by case): Excessive use of force Unlawful arrest and/or detention Sexual harassment Falsifying reports, statements, etc. Excessive driving complaints or at-fault collisions Page 2 of 11

3 To be considered, a completed application packet MUST include the following: 1. City of Goose Creek Employment Application AND professional resume. 2. City of Goose Creek Police Department pages 4 through 1 1. (Pages 1, 2, & 3 should be removed and retained or discarded at your discretion.). Note: All waivers contained in this supplemental packet must be signed and notarized where applicable. 3. (OUT OF STATE APPLICANTS ONLY) A certified copy of your driving record(s) bearing the signature of the agency director or authorized representative for your home-state motor vehicle department (Driving records must cover all states where a license was held over the past 5 years). You are encouraged to include the following with your packet if applicable: 1. A copy of your college transcript(s), if you have attended or graduated from college. 2. Copies of a ny certificates earned for relevant qualifications (Firearms, baton, chemical agents, advanced law enforcement courses, CPR, first-aid, etc.) You must bring the following information with you if contacted for a background interview: 1. Original or certified copy of your High School Diploma or State GED Certificate. 2. A copy of your final DD214 (military discharge) if applicable. 3. Original or certified copy of your birth certificate (You must include a copy of your Certificate of Naturalization if you became a United States citizen through the naturalization process.). 4. Your driver s license and social security card. Please read the following instructions carefully: Fill out the supplement on a computer and print it or type or handwrite in black ink. It is imperative that you answer ALL questions on this supplement as thoroughly as possible. Use a blank 8 ½ x 11 sheet to continue any answers beyond the format of the form. Answers that don t apply should be marked N/A. You must also answer questions with ABSOLUTE honesty. Any falsified information will result in the rejection of your application. Any incomplete or omitted answers to questions will be a cause for rejection of your application. Your ability to complete this supplement as requested will be evaluated and used as a basis for determining your ability to follow directions, your attention to detail, and may weigh appropriately upon any employment considerations. This supplement, when completed, will be used by a background investigator as an investigative aid. The information will remain with your application and will be maintained in accordance to City policy. Page 3 of 11

4 1. LAST NAME FIRST MIDDLE MAIDEN 2. Social Security Number 3. List ALL other names you have used. Include circumstances and dates when used. 4. Date of Birth 5. Place of Birth (City/State) 6. Beginning with present address, list ALL previous places of residence since age 18 (Attach a separate page, if necessary). FROM MONTH/YEAR TO MONTH/YEAR ADDRESS CITY STATE 7. Have you ever been dismissed from school or been subject to any dis ciplinary action, such as scholastic probation during your academic career? If yes, please indicate circumstances of rules infraction and action taken by school or university. 8. Fill in below the names of three (3) personal references not listed on the City of Goose Creek Employment Application. A. Name Phone Home Address Business, Occupation, or Profession Years Known Name of Business Business Address Phone B. Name Phone Home Address Business, Occupation, or Profession Years Known Name of Business Business Address Phone C. Name Phone Home Address Business, Occupation, or Profession Years Known Name of Business Business Address Phone Page 4 of 11

5 9. List ALL jobs not listed on the City of Goose Creek employment application. Include all part-time and summer jobs. Employer Address Supervisor Position Held Dates From / To / / Salary Full Duties: Part Reason for Leaving: Employer Address Supervisor Position Held Dates From / To / / Salary Full Duties: Part Reason for Leaving: Employer Address Supervisor Position Held Dates From / To / / Salary Full Duties: Part Reason for Leaving: Employer Address Supervisor Position Held Dates From / To / / Salary Full Duties: Part Reason for Leaving: Employer Address Supervisor Position Held Dates From / To / / Salary Full Duties: Part Reason for Leaving: 10. Are you currently a certified law enforcement officer (police officer/deputy)? If yes, please list state(s) of certification: Page 5 of 11

6 11. Have you ever applied to any law enforcement agency in South Carolina or any other state? If yes, give the name of the agency(s) and dates of application: 12. Have you ever worked for any law enforcement agency in South Carolina or any other state? If yes, give the name of the agency(s) and dates of employment: 13. Have you ever received any specialized training in computer applications? If yes, please list type of application(s), specific training, and date received: 14. Have you ever served in a military organization of the United States? (If yes, attach a copy of DD-214 for each period of service and proceed to question 15a. If no, go to question 16.) 15a.Provide the following information regarding your military service: Branch of Service Service Number Dates of Service Type(s) of Discharge: Honorable General Dishonorable Under Honorable Conditions Under less than Honorable Conditions Other (Explain) 15b.Were you ever court martialed, tried on charges, or subject of a summary court, deck court, Captain's Mast, company punishment, ARTICLE 15 UCMJ, or any other disciplinary action while in the armed forces? If yes, explain: 16. Starting with your current license, list all states in which you possessed a driver's license in the past five (5) years: State License Number From Month/Yr. To Month/Yr. Present Page 6 of 11

7 17. List ALL arrests OR convictions which are not listed on the City of Goose Creek employment application: Charge Date Agency Final Disposition 18. Are you now or have you ever been a member of any foreign or domestic organization, association, movement, group, or combination of persons which is totalitarian, fascist, communist, or subversive, or shows a p olicy of advocating the commission of acts of force or violence to deny other persons their rights under the Constitution of the United States, or which seeks to alter the form of Government of the United States, by unconstitutional means? If yes, explain: 19. Are you a U. S. Citizen? (You must attach a legible copy of your birth certificate or naturalization certificate from the United States Government). 20. Have you ever used illegal drugs? If yes, use list below to indicate use of illegal drugs: TYPE OF DRUG DATE FIRST USED DATE LAST USED Marijuana Cocaine Hashish LSD Opium Heroin Speed Quaaludes Steroids PCP Other (specify) 21. Have you ever sold illegal drugs? If yes, were you ever convicted? If convicted, was the conviction a felony or misdemeanor? 22. Has your credit record ever been considered unsatisfactory due to collections, charge-offs with a balance, liens, involuntary repossession, failure to pay just debts, judgments or foreclosures? If yes, explain: Page 7 of 11

8 Read the following statement carefully and sign: I hereby swear or affirm that there are no willful misrepresentations or omissions on this document. I am aware that should an investigation disclose such willful misrepresentations, falsifications or omissions, my application will be rejected and I will be disqualified from re-applying for employment with the City of Goose Creek. If after my acceptance of employment, subsequent investigation should disclose omissions or falsifications, it will be just cause for immediate dismissal. Signature Date THE CITY OF GOOSE CREEK IS AN EQUAL OPPORTUNITY EMPLOYER Page 8 of 11

9 Notice of Obtaining Consumer Report Printed Name In connection with your application for employment and/or your continued employment, the City of Goo se Creek may obtain a consumer report (as defined by the Fair Credit Reporting Act) concerning you from a consumer reporting agency. This report will be used for employment purposes. I have read and understand the above disclosure and hereby authorize the City of Goose Creek to obtain a consumer report. Signature Date Social Security Number Date of Birth Address City/State Zip Code SWORN to before me this day of, A. D., 20 Notary Public (SEAL) My Commission Expires: Page 9 of 11

10 Polygraph Examination Acknowledgement and Consent Applicant's Name Date of Birth Social Security # I have been advised and I am fully aware that I will be requested to submit to a polygraph examination. The purpose of the examination is to assist in verifying all information furnished in this application and obtained during applicant investigation. I am fully aware that my refusal to submit to the polygraph exam will terminate further consideration for my employment. I understand that I will be asked questions during my polygraph examination related to the following areas: * Accuracy of information provided during the employment process. * Theft * Drug and/or alcohol addictions * Drug use/sale * Prior arrests/criminal activity * Behavior that may lead to blackmail I understand that any willful attempt to deceive the polygraph examiner will result in my immediate disqualification from the employment process. After careful review and consideration of the aforementioned information: I am willing to take the polygraph examination. I am not willing to take the polygraph examination. Applicant's Signature Date SWORN to before me this day of, A. D., 20 Notary Public (SEAL) My Commission Expires: Page 10 of 11

11 CONSENT TO RELEASE INFORMATION AND RELEASE FROM LIABILITY TO WHOM IT MAY CONCERN: I am an applicant for a position with the City of Goose Creek Police Department. The Department needs to thoroughly investigate my employment background and personal history to evaluate my qualifications to hold the position for which I have applied. I have authorized the Department to gather all available information regarding my employment background, personal history, and other information, which may be of a confidential or privileged nature. I, the undersigned, authorize you to furnish the Goose Creek Police Department any and all information that you have concerning me, including without limitation my work record, my background and reputation, my driving history, criminal history, including any arrest records and any information contained in any investigatory files, my military service records, my educational background and records, my financial status, and other such information and records as you may have in your possession relating to me. Information of a confidential or privileged nature may be included in the materials you provide to Goose Creek Police Department. I request your cooperation in supplying this information to the Goose Creek Police Department. I hereby agree to release you and those who furnish any of the above information, your company or organization, and the City of Goose Creek, its employees and the City of Goose Creek Police Department from any and all liability for any damage s of whatever kind to me, my family, heirs, or associates, which may result from furnishing the requested information. I understand my rights under Title 5, United States Code, Section 552a, the Privacy Act of 1974, with regard to disclosure of records, and I waive those rights with the understanding that information furnished will be used by the Goose Creek Police Department in conjunction with employment procedures. I will make no attempt to gain access to the information provided by you to the Goose Creek Police Department. Print Full Name Including Maiden Name Date of Birth Race Sex Signature of Full Name Drivers License Number Social Security Number Address City State Zip Code Home Phone Number Work Phone Number SWORN to before me this day of, A.D., 20 (SEAL) Notary Public My Commission Expires: Page 11 of 11

Chesapeake Police Department

Chesapeake Police Department Chesapeake Police Department 2018 Personal History Statement for Dispatcher Applicants Name: Last Name, First Name Middle Name Rev. 12/2017 Instructions on Completing This Packet READ CAREFULLY Thank you

More information

ORO VALLEY POLICE DEPARTMENT INTERN BACKGROUND QUESTIONNAIRE

ORO VALLEY POLICE DEPARTMENT INTERN BACKGROUND QUESTIONNAIRE INTERN BACKGROUND QUESTIONNAIRE NAME: PHONE# ( ) EMAIL: Best phone # to reach you FOLLOW DIRECTIONS CAREFULLY 1. Use BLUE ink to complete questionnaire. 2. Print legibly in your own handwriting. 3. Read

More information

PERSONAL HISTORY STATEMENT POLICE OFFICER

PERSONAL HISTORY STATEMENT POLICE OFFICER PERSONAL HISTORY STATEMENT POLICE OFFICER Printed Name (Last, First, Middle): Social Security Number: Date: INSTRUCTIONS TO THE APPLICANT The information in this Personal History Statement will be used

More information

Bullhead City Police Department Explorer Application Instructions

Bullhead City Police Department Explorer Application Instructions Bullhead City Police Department Explorer Application Instructions This application will be used to determine your eligibility for acceptance to the Bullhead City Police Department Explorer. Please follow

More information

POLICE EMPLOYMENT APPLICATION Post Office Box 975, 1 Lake Street, Avon, CO (Town main line) or (Human Resources)

POLICE EMPLOYMENT APPLICATION Post Office Box 975, 1 Lake Street, Avon, CO (Town main line) or (Human Resources) POLICE EMPLOYMENT APPLICATION Post Office Box 975, 1 Lake Street, Avon, CO 81620 970-748-4000 (Town main line) or 970-748-4025 (Human Resources) INSTRUCTIONS FOR COMPLETING APPLICATION PLEASE PRINT LEGIBLY

More information

NATIONAL PARK SERVICE SEASONAL LAW ENFORCEMENT TRAINING (NPS-SLET) RECRUIT APPLICANT PERSONAL HISTORY STATEMENT

NATIONAL PARK SERVICE SEASONAL LAW ENFORCEMENT TRAINING (NPS-SLET) RECRUIT APPLICANT PERSONAL HISTORY STATEMENT FORM F - 3 (Rev. 02/2012) NATIONAL PARK SERVICE SEASONAL LAW ENFORCEMENT TRAINING (NPS-SLET) RECRUIT APPLICANT PERSONAL HISTORY STATEMENT THIS DOCUMENT MUST BE NOTARIZED PRIOR TO SUBMISSSION READ ALL INSTRUCTIONS/QUESTIONS

More information

EMPLOYMENT APPLICATION AN EQUAL OPPORTUNITY EMPLOYER Read below before continuing filling out the application.

EMPLOYMENT APPLICATION AN EQUAL OPPORTUNITY EMPLOYER Read below before continuing filling out the application. updated 1/24/2017 POLICE DEPARTMENT Applications accepted for posted positions ONLY. A new application must be completed for each posting. Completed applications must be returned to City Hall, 215 N Broad

More information

OLIVE BRANCH POLICE DEPARTMENT APPLICATION PACKET

OLIVE BRANCH POLICE DEPARTMENT APPLICATION PACKET OLIVE BRANCH POLICE DEPARTMENT APPLICATION PACKET Read ALL information carefully and fill out all forms COMPLETELY. This application for employment will be considered active for a period of time not to

More information

OLIVE BRANCH POLICE DEPARTMENT APPLICATION PACKET

OLIVE BRANCH POLICE DEPARTMENT APPLICATION PACKET OLIVE BRANCH POLICE DEPARTMENT APPLICATION PACKET Read ALL information carefully and fill out all forms COMPLETELY. This application for employment will be considered active for a period of time not to

More information

PRELIMINARY PERSONAL HISTORY STATEMENT FOR POLICE OFFICER CANDIDATES NOTE THE FOLLOWING INFORMATION

PRELIMINARY PERSONAL HISTORY STATEMENT FOR POLICE OFFICER CANDIDATES NOTE THE FOLLOWING INFORMATION PRELIMINARY PERSONAL HISTORY STATEMENT FOR POLICE OFFICER CANDIDATES The information in this document will be used to evaluate your qualifications and credentials for Public Safety positions. In order

More information

TOWN OF COLUMBINE VALLEY POLICE DEPARTMENT APPLICATION FOR EMPLOYMENT

TOWN OF COLUMBINE VALLEY POLICE DEPARTMENT APPLICATION FOR EMPLOYMENT TOWN OF COLUMBINE VALLEY POLICE DEPARTMENT APPLICATION FOR EMPLOYMENT BASIC REQUIREMENTS SEX: AGE: EDUCATION: HEIGHT & WEIGHT: EYESIGHT: Equal Opportunity Employer Officer Position-Between 21 and 65 Years

More information

Position applied for: Date: Human Resources City Hall 5047 Union Street Union City, Georgia 30291

Position applied for: Date: Human Resources City Hall 5047 Union Street Union City, Georgia 30291 Human Resources City Hall 5047 Union Street Union City, Georgia 30291 All information provided on this application MUST BE COMPLETE so that all applications can be given equitable consideration. All qualified

More information

Amory Police Department Chief Ronnie Bowen, 200 South Front Street, Amory, MS (662) FAX (662)

Amory Police Department Chief Ronnie Bowen, 200 South Front Street, Amory, MS (662) FAX (662) Amory Police Department Chief Ronnie Bowen, 200 South Front Street, Amory, MS 38821 (662) 256-2676 FAX (662) 256-6330 Page 1 of 15 LAW ENFORCEMENT EMPLOYMENT APPLICATION FORM DO NOT WRITE IN THIS SPACE

More information

DEPARTMENT of POLICE. City of STURGIS, MICHIGAN

DEPARTMENT of POLICE. City of STURGIS, MICHIGAN DEPARTMENT of POLICE City of STURGIS, MICHIGAN Employment Application And Personal History Statement AN EQUAL OPPORTUNITY EMPLOYER 1 GENERAL INFORMATION Read Carefully Before You Complete This Application

More information

Questionnaire Last Name First Name Middle Name Social Security Number. 3. 3A. Alias(es), Nickname(s) Maiden Name, Other Changes in Name

Questionnaire Last Name First Name Middle Name Social Security Number. 3. 3A. Alias(es), Nickname(s) Maiden Name, Other Changes in Name General Instructions This application consists of several sections: a questionnaire; a Notification Procedure Release; a Verification; a General waiver; a Polygraph Release; and a description of essential

More information

Hendry County Sheriff s Office Sheriff Steve Whidden PRESCREEN QUESTIONNAIRE

Hendry County Sheriff s Office Sheriff Steve Whidden PRESCREEN QUESTIONNAIRE Hendry County Sheriff s Office Sheriff Steve Whidden Date: Position applied for: Name: SS#: / / DOB / / Address: City: State: Zip: Home Phone: Cell Phone: PRESCREEN QUESTIONNAIRE A thorough background

More information

1. 2. Last Name First Name Middle Name Social Security Number. 3. 3A. ( ) Alias(es), Nickname(s) Maiden Name, Other Changes in Name Telephone Number

1. 2. Last Name First Name Middle Name Social Security Number. 3. 3A. ( ) Alias(es), Nickname(s) Maiden Name, Other Changes in Name Telephone Number POLICE OFFICER APPLICATION SWARTHMORE BOROUGH POLICE DEPARTMENT GENERAL INSTRUCTIONS: This application consists of several sections: a questionnaire; a Notification Procedure Release; a Verification; a

More information

Robertson County Sheriff's Office

Robertson County Sheriff's Office Robertson County Sheriff's Office 507 South Brown Street Springfield, Tennessee 37172 (615) 384-7971 www.robertsonsheriff.com Sheriff William C. Holt Chief Deputy Michael Van Dyke Application for Employment

More information

EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION EMPLOYMENT APPLICATION Eyerly Ball CMHS is an Equal Opportunity Employer. Federal & State law prohibit discrimination on the basis of race, color, religion, gender identity, age, disability, sexual orientation,

More information

Memphis Police Department

Memphis Police Department Memphis Police Department Police Officer and Police Service Technician Application Packet Dr. W.W. Herenton James H. Bolden Mayor of Memphis Director of Police Memphis Police Department Personal History

More information

EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION EMPLOYMENT APPLICATION POLICE OFFICER APPLICANTS READ THIS CAREFULLY!!! APPLICATIONS: Applications must be turned into the Montgomery Township Police Department (1001 Stump Road, P.O. Box 68, Montgomeryville,

More information

PRELIMINARY PERSONAL HISTORY STATEMENT FOR POLICE OFFICER CANDIDATES NOTE THE FOLLOWING INFORMATION

PRELIMINARY PERSONAL HISTORY STATEMENT FOR POLICE OFFICER CANDIDATES NOTE THE FOLLOWING INFORMATION PRELIMINARY PERSONAL HISTORY STATEMENT FOR POLICE OFFICER CANDIDATES The information in this document will be used to compare your qualifications and credentials to those of other candidates under consideration

More information

SUPERIOR COURT OF THE STATE OF ARIZONA IN AND FOR THE COUNTY OF MOHAVE PROBATION DEPARTMENT APPLICANT INFORMATION SHEET

SUPERIOR COURT OF THE STATE OF ARIZONA IN AND FOR THE COUNTY OF MOHAVE PROBATION DEPARTMENT APPLICANT INFORMATION SHEET SUPERIOR COURT OF THE STATE OF ARIZONA IN AND FOR THE COUNTY OF MOHAVE PROBATION DEPARTMENT APPLICANT INFORMATION SHEET About the Selection Process: The employment selection process with the Mohave County

More information

TOWN OF LAKEVIEW CHIEF OF POLICE APPLICATION

TOWN OF LAKEVIEW CHIEF OF POLICE APPLICATION TOWN OF LAKEVIEW CHIEF OF POLICE APPLICATION The Town of Lakeview is an equal employment opportunity employer. The Town considers applicants for all positions without regard to race, color, religion, sex,

More information

LOS ANGELES POLICE DEPARTMENT Personal History Form for Police Officer Applicants

LOS ANGELES POLICE DEPARTMENT Personal History Form for Police Officer Applicants Background interview: Date: Time: Report to: LAPD Administrative Investigation Section Personnel Department Building 700 E. Temple Street, Room B-22 LOS ANGELES POLICE DEPARTMENT Personal History Form

More information

SCOTTSBURG FIRE DEPARTMENT APPLICATION of MEMBERSHIP

SCOTTSBURG FIRE DEPARTMENT APPLICATION of MEMBERSHIP SCOTTSBURG FIRE DEPARTMENT APPLICATION of MEMBERSHIP Scottsburg Fire Department Applicant: To ensure the continuation of prestige and reputation of the department each applicant will be required to met

More information

KCJ & RJC. Important Information for Filling Out Application:

KCJ & RJC. Important Information for Filling Out Application: KCJ & RJC Important Information for Filling Out Application: 1) Please read the complete application thoroughly before beginning. County clearance of this application will allow you to carry AA meetings

More information

DENVER CITY POLICE DEPARTMENT

DENVER CITY POLICE DEPARTMENT **PLEASE RETURN THIS FORM WITH YOUR APPLICATION AND RELEASE FORM** JACK D. MILLER CHIEF OF POLICE DENVER CITY POLICE DEPARTMENT P.O. DRAWER 1539 DENVER CITY, TEXAS 79323 (806)592-3516 APPLICANT INFORMATION

More information

REQUIREMENTS FOR EMPLOYMENT: To Be Provided By Applicant ***THESE DOCUMENTS ARE MANDATORY AND WILL BE VERIFIED AT THE TIME OF INITIAL INTERVIEW.

REQUIREMENTS FOR EMPLOYMENT: To Be Provided By Applicant ***THESE DOCUMENTS ARE MANDATORY AND WILL BE VERIFIED AT THE TIME OF INITIAL INTERVIEW. REQUIREMENTS FOR EMPLOYMENT: To Be Provided By Applicant 1. COPY OF HIGH SCHOOL OR COLLEGE TRANSCRIPT 2. VAILD NORTH CAROLINA DRIVERS LICENSE 3. SOCIAL SECURITY CARD 4. YEARLY TB SKIN TEST 5. COPY OF CURRENT

More information

City of Electra Police Dept. 111 E Cleveland Electra, Texas TEL: (940) FAX: (940)

City of Electra Police Dept. 111 E Cleveland Electra, Texas TEL: (940) FAX: (940) City of Electra Police Dept. 111 E Cleveland Electra, Texas 76360 TEL: (940)495-2131 FAX: (940)495-2342 michael.dozier@cityofelectra.com PLEASE READ FIRST: Thank you for your interest in employment with

More information

WILLISTON POLICE DEPARTMENT PERSONAL HISTORY QUESTIONNAIRE INSTRUCTIONS

WILLISTON POLICE DEPARTMENT PERSONAL HISTORY QUESTIONNAIRE INSTRUCTIONS WILLISTON POLICE DEPARTMENT PERSONAL HISTORY QUESTIONNAIRE INSTRUCTIONS Be sure to sign and date the Authorization for Release form that accompanies this questionnaire. If you have any questions, please

More information

CITY OF MOSCOW POLICE DEPARTMENT LAW ENFORCEMENT APPLICATION FOR EMPLOYMENT

CITY OF MOSCOW POLICE DEPARTMENT LAW ENFORCEMENT APPLICATION FOR EMPLOYMENT CITY OF MOSCOW POLICE DEPARTMENT LAW ENFORCEMENT APPLICATION FOR EMPLOYMENT City of Moscow Human Resources www.ci.moscow.id.us 206 East 3 rd Street (208) 883-7000 phone P. O. Box 9203 (208) 883-7019 TDD

More information

ROUGH ROCK COMMUNITY SCHOOL, INC. HC 61 Box 5050 PTT Rough Rock, Arizona Phone: (928)

ROUGH ROCK COMMUNITY SCHOOL, INC. HC 61 Box 5050 PTT Rough Rock, Arizona Phone: (928) ROUGH ROCK COMMUNITY SCHOOL, INC. HC 61 Box 5050 PTT Rough Rock, Arizona 86503 Phone: (928) 728 3700 CLASSIFIED EMPLOYMENT APPLICATION Date: Please complete entire application in full. Do not use refer

More information

Michael Gayoso, Jr. Office of the County Attorney TH

Michael Gayoso, Jr. Office of the County Attorney TH Michael Gayoso, Jr. Office of the County Attorney TH 11 Judicial District/Crawford County, Kansas DRUG DIVERSION PROGRAM Pursuant to K.S.A. 22-2906 et seq. the Crawford County Attorney of the Eleventh

More information

Shawnee Hills Police Department HIRING PROCESS & STANDARDS Police Officer

Shawnee Hills Police Department HIRING PROCESS & STANDARDS Police Officer Shawnee Hills Police Department HIRING PROCESS & STANDARDS Police Officer Probation Period: 365 Days Revision Date: 09/11/2015 Nature of Work General Description Under the direct supervision of a Sergeant

More information

Westminster Fire Engine & Hose Co., No. 1

Westminster Fire Engine & Hose Co., No. 1 Westminster Fire Engine & Hose Co., No. 1 Volunteering Today for Your Tomorrow P.O. Box 357 28 John Street Westminster, Maryland 21158 410-848-1800 Fax: 410-848-3407 An Equal Opportunity Employer PRE-

More information

City of Waco Application for Police Recruit

City of Waco Application for Police Recruit City of Waco Application for Police Recruit 3115 Pine Ave * Waco, TX 76708-2570 * www.wacopolice.com INSTRUCTIONS: Answer each question clearly and completely. If questions are not applicable, enter NA.

More information

APPLICATION FOR DENTAL HYGIENE/ PROVISIONAL LICENSURE

APPLICATION FOR DENTAL HYGIENE/ PROVISIONAL LICENSURE APPLICATION FOR DENTAL HYGIENE/ PROVISIONAL LICENSURE MATERIALS TO BE SUBMITTED (Retain this Sheet for Your Records) The Board prefers that the materials listed below be submitted with your application;

More information

Elko County is an Equal Opportunity Provider and Employer

Elko County is an Equal Opportunity Provider and Employer Name: Address: ELKO COUNTY EMPLOYMENT APPLICATION Mailing: 571 Idaho Street, Elko, NV 89801 Physical: 540 Court Street, Elko, NV 89801 (775) 738-4375 telephone (775) 738-5984 fax Elko County is an Equal

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT APPLICATION FOR EMPLOYMENT Date: Please Print Clearly And Answer All Questions. Résumés Are Not Substitute For A Completed Application. We are an equal opportunity employer. Applicants are considered for

More information

Pre-Screening Questionnaire

Pre-Screening Questionnaire Pre-Screening Questionnaire Position Applying For: Date: Name (Last) (First) MI Other Names used (including alias and maiden names) Social Security Number - - Date of Birth - - Sex- Race- (for stastical,

More information

POLICE DEPARTMENT APPLICANT REQUIREMENTS

POLICE DEPARTMENT APPLICANT REQUIREMENTS POLICE DEPARTMENT APPLICANT REQUIREMENTS ELIGIBILITY REQUIREMENTS Applicants must be 21 years of age and have not reached the age of 51 before the date of hire. Applicants must hold a valid Texas Driver

More information

THE FOLLOWING ITEMS MUST BE SENT IN WITH YOUR APPLICATION IN ORDER FOR IT TO BE CONSIDERED COMPLETE:

THE FOLLOWING ITEMS MUST BE SENT IN WITH YOUR APPLICATION IN ORDER FOR IT TO BE CONSIDERED COMPLETE: Application for Pardon Consideration The Governor of the State of Oklahoma may pardon only Oklahoma convictions. The Governor cannot pardon a federal criminal offense or an offense from another state.

More information

IMPORTANT INFORMATION READ CAREFULLY

IMPORTANT INFORMATION READ CAREFULLY IMPORTANT INFORMATION READ CAREFULLY Civil Service Commission Amy Lay, Civil Service Director City of Denison P.O. BOX 347 Denison, TX 75021 DATE POSTED: January 16, 2018 in the Main Lobby, more than 10

More information

APPLICATION FOR EMPLOYMENT. Name: 1. These forms must be typewritten or printed in blue or black ink by the applicant himself/herself.

APPLICATION FOR EMPLOYMENT. Name: 1. These forms must be typewritten or printed in blue or black ink by the applicant himself/herself. Town of Westport Department of Police 818 Main Road Westport, MA 02790-4311 Tel. # 508.636.1122 - Fax # 508.636.4108 - CJIS: WST - NCIC: MA0032000 KEITH A. PELLETIER Chief of Police APPLICATION FOR EMPLOYMENT

More information

MANSFIELD ISD POLICE DEPARTMENT

MANSFIELD ISD POLICE DEPARTMENT APPLICANT PERSONAL HISTORY STATEMENT NAME: DATE SUBMITTED : I am applying for: [ [ [ ] Peace Officer PID# # ] Telecommunicator PID# ] Civilian Employme ent Mansfield ISD Police Department 1522 N. Walnut

More information

CITY OF LAREDO CIVIL SERVICE COMMISSION

CITY OF LAREDO CIVIL SERVICE COMMISSION CITY OF LAREDO CIVIL SERVICE COMMISSION MINIMUM STANDARDS FOR POLICE DEPARTMENT The City of Laredo is an equal opportunity employer and is committed to evaluating each candidate on a nondiscriminatory

More information

EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION Name Address Eureka County P.O. Box 852 Eureka, NV 89316 EMPLOYMENT APPLICATION An Equal Opportunity If you believe you require an accommodation during the selection process, please contact us to make

More information

INDIAN RIVER STATE COLLEGE LAW ENFORCEMENT ACADEMY TRACK Application

INDIAN RIVER STATE COLLEGE LAW ENFORCEMENT ACADEMY TRACK Application INDIAN RIVER STATE COLLEGE LAW ENFORCEMENT ACADEMY TRACK Application Photo WILLFULLY OR KNOWINGLY FALSIFYING THIS APPLICATION WILL RESULT IN DISQUALIFICATION FROM THE SELECTION CENTER PROCESS OR IF DISCOVERED

More information

EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION CITY OF JONESBORO 124 North Avenue Jonesboro, Georgia 30236 www.jonesboroga.com EMPLOYMENT APPLICATION THE CITY OF JONESBORO ONLY ACCEPTS APPLICATIONS FOR CURRENTLY POSTED POSITIONS. UNSOLICITED APPLICATIONS

More information

General Plumbing Supply Co., Inc. P.O. Box San Luis Road Walnut Creek, CA 94597

General Plumbing Supply Co., Inc. P.O. Box San Luis Road Walnut Creek, CA 94597 General Plumbing Supply Co., Inc. P.O. Box 4666 1530 San Luis Road Walnut Creek, CA 94597 An Equal Opportunity Employer PLEASE PRINT Date: Name: Last Middle First Business Telephone: ( ) Home Telephone:

More information

Application for Middleton Firefighter Middleton Fire District 7600 University Ave, Middleton WI 53562

Application for Middleton Firefighter Middleton Fire District 7600 University Ave, Middleton WI 53562 Application for Middleton Firefighter Middleton Fire District 7600 University Ave, Middleton WI 53562 Instructions: Please type or print in ink an answer to every question, if an answer does not apply,

More information

City of Fond du Lac - Application for Employment

City of Fond du Lac - Application for Employment City of Fond du Lac - Application for Employment AN EQUAL OPPORTUNITY EMPLOYER APPLICATION FOR EMPLOYMENT This information is for official use only and will not be released to unauthorized persons nor

More information

CITY OF HOLLYWOOD, FLORIDA

CITY OF HOLLYWOOD, FLORIDA Name: Job Posting: CJBAT Score: Date: Date Applied: Position Type: Veteran Yes / No Points: State Cert. Yes / No Date: Seniority Points: For Official Use Only BMST Yes / No Date: Hollywood Explorer: Swim

More information

LAW ENFORCEMENT EMPLOYMENT APPLICATION FORM

LAW ENFORCEMENT EMPLOYMENT APPLICATION FORM Revised 9 / 1 OKALOOSA COUNTY SHERIFF'S OFFICE LAW ENFORCEMENT EMPLOYMENT APPLICATION FORM The Sheriff's Office is an Equal Employment Opportunity Employer. We consider applicants for all positions without

More information

Keokuk Police Department

Keokuk Police Department Keokuk Police Department Mission Statement: The Keokuk Police Department is committed to providing Quality Professional Law Enforcement Services to the community. History: The Keokuk Police Department

More information

Las Vegas Metropolitan Police Department CONCEALED FIREARM PERMIT APPLICATION

Las Vegas Metropolitan Police Department CONCEALED FIREARM PERMIT APPLICATION Submit completed application in person at: Las Vegas Metropolitan Police Department RECORDS & FINGERPRINT BUREAU (702)828-3271 400 S Martin Luther King Blvd - Bldg C Las Vegas NV 89106 Monday Friday (excluding

More information

IRONWORKER EMPLOYEES BENEFIT CORPORATION Employment Application

IRONWORKER EMPLOYEES BENEFIT CORPORATION Employment Application IRONWORKER EMPLOYEES BENEFIT CORPORATION Employment Application An Equal Opportunity Employer Please Print Date Last First Middle Present No. & Street Permanent (if different from present address) No.

More information

Weymouth Police Department 140 Winter Street Weymouth, MA 02188

Weymouth Police Department 140 Winter Street Weymouth, MA 02188 Weymouth Police Department 140 Winter Street Weymouth, MA 02188 To: Police Candidate Your name has been certified by the Massachusetts Human Resources Division as being eligible for the position of police

More information

APPLICATION FOR LICENSURE AS MARRIAGE AND FAMILY THERAPIST SUPERVISOR

APPLICATION FOR LICENSURE AS MARRIAGE AND FAMILY THERAPIST SUPERVISOR SC DEPARTMENT OF LABOR, LICENSING AND REGULATION BOARD OF EXAMINERS FOR THE LICENSURE OF PROFESSIONAL COUNSELORS, MARRIAGE AND FAMILY THERAPISTS, AND PSYCHO-EDUCATIONAL SPECIALISTS Post Office Box 11329

More information

NORCAL Ambulance Employment Application. ( ) - ( ) - Home Phone Cell Phone Address

NORCAL Ambulance Employment Application. ( ) - ( ) - Home Phone Cell Phone  Address NORCAL Ambulance Employment Application An Equal Opportunity Employer Please Print Date Last Name First Name Middle Present Address - No. & Street Zip Permanent Address (if different from present address)

More information

APPLICATION FOR POLICE DISPATCHER

APPLICATION FOR POLICE DISPATCHER APPLICATION FOR POLICE DISPATCHER Applicant s name: Last First Middle Brewster Police Department 631 Harwich Road Brewster, Massachusetts 02631 1. These forms must be typewritten or printed in blue or

More information

Patrol Officer Personal History Statement

Patrol Officer Personal History Statement Patrol Officer Personal History Statement City of Cleveland Department of Public Safety Division of Police 1300 Ontario Cleveland, Ohio 44113 The information you give to the City of Cleveland in this Personal

More information

Sanco Pipelines, Inc. Employment Application An Equal Opportunity Employer

Sanco Pipelines, Inc. Employment Application An Equal Opportunity Employer Sanco Pipelines, Inc. Employment Application An Equal Opportunity Employer Please Print Date Last Name First Name Middle Present Address - No. & Street City State Zip Permanent Address (if different from

More information

EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION EMPLOYMENT APPLICATION Paramount Residential Mortgage Group, Inc. ( PRMG ) is an Equal Opportunity Employer. Please Print Date Last Name First Name Middle Present Address No. & Street City State Zip Permanent

More information

Signal Hill Police Department PRE-INVESTIGATIVE QUESTIONNAIRE

Signal Hill Police Department PRE-INVESTIGATIVE QUESTIONNAIRE APPLICANT: As an Applicant for a position with the Signal Hill Department, you are required to complete this form in it s entirety. You are hereby admonished that any false statement or omission on this

More information

Please tell us how you heard of Jack Harwell Detention Center. Newspaper Ad. Texas Workforce Commission. On- Line Advertising

Please tell us how you heard of Jack Harwell Detention Center. Newspaper Ad. Texas Workforce Commission. On- Line Advertising Please tell us how you heard of Jack Harwell Detention Center. Newspaper Ad Sign in front of Jack Harwell Employee who works here now and who Texas Workforce Commission Bill Board On- Line Advertising

More information

Employment Application

Employment Application Today s Date Employment Application 424 Prescott St. Greensboro, NC 27401 336-272-4400 This is a Drug-Free Workplace Offering Equal Employment Opportunities YOUR PERSONAL INFORMATION Last Name First Name

More information

EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION EMPLOYMENT APPLICATION An Equal Opportunity Employer Please Print Date Last First Middle Present No. & Street Permanent (if different from present address) No. & Street ( ) - ( ) - Business Phone Home

More information

ROCKBRIDGE REGIONAL. Citizen s Police Academy Application

ROCKBRIDGE REGIONAL. Citizen s Police Academy Application ROCKBRIDGE REGIONAL Citizen s Police Academy Application Complete and return to: Buena Vista Police Department c/o Cindy Harrison 306 Park Avenue Buena Vista VA 24416 (540) 261-6174 pdinfo@bvcity.org Starts

More information

Information Regarding Dental Licensure by Regional Examination for In State Applicants

Information Regarding Dental Licensure by Regional Examination for In State Applicants BOARD OF DENTAL EXAMINERS OF ALABAMA Stadium Parkway Office Center-Suite 112 5346 Stadium Trace Parkway Hoover, Al 35244-4583 PHONE 205-985-7267 FAX 205-985-0674 e-mail: bdeal@dentalboard.org Information

More information

BANNOCK COUNTY JUVENILE JUSTICE AND DETENTION BACKGROUND INFORMATION

BANNOCK COUNTY JUVENILE JUSTICE AND DETENTION BACKGROUND INFORMATION BANNOCK COUNTY JUVENILE JUSTICE AND DETENTION BACKGROUND INFORMATION A. PERSONAL BACKGROUND INFORMATION Employing Agency: DATE: 1. Applicant s Social Security Number: - - 2. Place of Birth Date of Birth

More information

Application for Employment

Application for Employment Application for Employment Today s Date Your Personal Information Name Last First Middle Address City State Zip Code Home Telephone Cellular Telephone E-Mail Address Preferred Method of Contact: Home Telephone

More information

West Virginia Board of Optometry

West Virginia Board of Optometry West Virginia Board of Optometry 179 Summers Street, Suite 231 Charleston, WV 25301 Phone: 304/558-5901 Fax: 304/558-5908 OFFICE USE ONLY Examination: Issued License Number Endorsement: Issued License

More information

RECRUIT PERSONAL HISTORY STATEMENT

RECRUIT PERSONAL HISTORY STATEMENT CITY OF ROCKWALL FIRE DEPARTMENT RECRUIT PERSONAL HISTORY STATEMENT READ THESE INSTRUCTIONS CAREFULLY BEFORE PROCEEDING These instructions are provided as a guide to assist you in properly completing your

More information

APPLICATION FOR DENTAL/PROVISIONAL LICENSURE

APPLICATION FOR DENTAL/PROVISIONAL LICENSURE APPLICATION FOR DENTAL/PROVISIONAL LICENSURE MATERIALS TO BE SUBMITTED (Please Retain Sheet for Your Records) The Board prefers that the materials listed below be submitted with your application; however,

More information

NEW MEXICO SCHOOL FOR THE DEAF 1060 Cerrillos Road Santa Fe, NM (505) V/TTY/VP (505) Fax Website:

NEW MEXICO SCHOOL FOR THE DEAF 1060 Cerrillos Road Santa Fe, NM (505) V/TTY/VP (505) Fax Website: NEW MEXICO SCHOOL FOR THE DEAF 1060 Cerrillos Road Santa Fe, NM 87505 (505) 476-6300-V/TTY/VP (505)476-6315-Fax Website: www.nmsd.k12.nm.us EMPLOYMENT APPLICATION Application : Last Name: First Name: Middle

More information

INSTRUCTIONS FOR COMPLETING APPLICATION

INSTRUCTIONS FOR COMPLETING APPLICATION KISSIMMEE POLICE DEPARTMENT 8 N. Stewart Avenue Kissimmee, Florida 34741 (407) 518-2458 Volunteer Application EQUAL OPPORTUNITY EMPLOYER The City of Kissimmee does not discriminate on the basis of race,

More information

Employment Application Conico Management

Employment Application Conico Management Employment Application Conico Management An Equal Opportunity Employer Please Print Date Last First Middle Present No. & Street Permanent (if different from present address) No. & Street ( ) - ( ) - Business

More information

POSITION APPLIED FOR:

POSITION APPLIED FOR: APPLICATION FOR EMPLOYMENT Human Resources Department 9770 Culver Boulevard Culver City, CA 90232-0507 (310) 253-5640 Main line (310) 253-5651 Job line TDD (310) 253-5647 (Hearing Impaired Only) An Equal

More information

Choctaw Nation Gaming Commission P.O. Box 5229 Durant, OK Phone: (580) Fax: (580)

Choctaw Nation Gaming Commission P.O. Box 5229 Durant, OK Phone: (580) Fax: (580) Choctaw Nation Gaming Commission P.O. Box 5229 Durant, OK 74702-5229 Phone: (580) 924-8112 Fax: (580) 920-4966 Gaming License Application Instructions: 1. Original application must be submitted. A photocopy

More information

Application for Employment

Application for Employment Application for Employment Today s Date Your Personal Information Name Last First Middle Address City State Zip Code Home Telephone Cellular Telephone E-Mail Address Preferred Method of Contact: Home Telephone

More information

KUTZTOWN BOROUGH POLICE DEPARTMENT SUMMARY OF APPLICATION AND HIRING PROCESS FOR PATROL OFFICER

KUTZTOWN BOROUGH POLICE DEPARTMENT SUMMARY OF APPLICATION AND HIRING PROCESS FOR PATROL OFFICER In order to be eligible for participation in any Examination for any position with the Police Department, every Applicant must submit a completed application form to the Kutztown Borough Civil Service

More information

City of Newark Newark Boulevard, 4th Floor Newark, CA

City of Newark Newark Boulevard, 4th Floor Newark, CA City of Newark 37101 Newark Boulevard, 4th Floor Newark, CA 94560-3796 EMPLOYMENT APPLICATION Date Received: Accepted Rejected Rejection for: Late Application Incomplete Application Experience Education

More information

APPLICATION FOR DENTAL HYGIENE/ PROVISIONAL LICENSURE

APPLICATION FOR DENTAL HYGIENE/ PROVISIONAL LICENSURE APPLICATION FOR DENTAL HYGIENE/ PROVISIONAL LICENSURE MATERIALS TO BE SUBMITTED (Retain this Sheet for Your Records) The Board prefers that the materials listed below be submitted with your application;

More information

City of Milford, Connecticut

City of Milford, Connecticut City of Milford, Connecticut DEPARTMENT OF POLICE 430 Boston Post Road * Milford, CT 06460-2570 Telephone (203) 878-6551 APPLICATION FOR INTERNSHIP NAME OF APPLICANT: APPLICANT: a copy of the following,

More information

IMPORTANT: INSTRUCTIONS TO APPLY FOR POLICE DISPATCHER EXAMINATION.

IMPORTANT: INSTRUCTIONS TO APPLY FOR POLICE DISPATCHER EXAMINATION. IMPORTANT: INSTRUCTIONS TO APPLY FOR POLICE DISPATCHER EXAMINATION. This packet contains the following items; please follow instructions carefully and call with questions. a. This instructional page (keep

More information

PERSONAL DATA Last Name First Middle Social Security No.

PERSONAL DATA Last Name First Middle Social Security No. APPLICATION FOR EMPLOYMENT CITY OF BRIDGEPORT 900 THOMPSON STREET BRIDGEPORT, TEXAS 76426 The City of Bridgeport is an Equal Opportunity Employer. It is the policy of the City of Bridgeport to provide

More information

CITY OF MILTON APPLICATION FOR EMPLOYMENT Fire Fighter Positions

CITY OF MILTON APPLICATION FOR EMPLOYMENT Fire Fighter Positions CITY OF MILTON APPLICATION FOR EMPLOYMENT Fire Fighter Positions The City of Milton is an equal opportunity employer. It adheres to a policy of making employment decisions without regard to race, color,

More information

CITY OF LAKE WORTH, TEXAS APPLICATION FOR EMPLOYMENT An Equal Opportunity Employer

CITY OF LAKE WORTH, TEXAS APPLICATION FOR EMPLOYMENT An Equal Opportunity Employer CITY OF LAKE WORTH, TEXAS APPLICATION FOR EMPLOYMENT An Equal Opportunity Employer It is the policy of the City of Lake Worth not to discriminate in its hiring or employment practices on the basis of race,

More information

APPLICATION FOR LMSW LICENSURE

APPLICATION FOR LMSW LICENSURE APPLICATION FOR LMSW LICENSURE Please type or print all information. Incomplete applications will be returned. When space provided is insufficient, attach additional sheets, with your name and Social Security

More information

Director of Public Safety Wixom Police & Fire Departments City of Wixom, Michigan

Director of Public Safety Wixom Police & Fire Departments City of Wixom, Michigan Director of Public Safety Wixom Police & Fire Departments City of Wixom, Michigan Salary: $74,833 - $97,283 The City of Wixom is accepting resumes and cover letters from those qualified individuals who

More information

DRIVER PRE-EMPLOYMENT APPLICATION

DRIVER PRE-EMPLOYMENT APPLICATION DRIVER PRE-EMPLOYMENT APPLICATION QUALIFIED APPLICANTS ARE CONSIDERED WITHOUT REGARD TO RACE, COLOR, SEX, NATIONAL ORIGIN, AGE, MARITAL STATUS, RELIGION, SEXUAL ORIENTATION, VETERAN S STATUS APPLICANT:

More information

Application for Employment

Application for Employment Tuba City Regional Health Care Corporation Human Resources Department 167 N. Main Street, P.O. Box 600 Tuba City, Arizona 86045-0600 Phone: (928) 283-2432 Fax: (928) 283-2042 Application for Employment

More information

Clive Police Department Civil Service Packet 2017

Clive Police Department Civil Service Packet 2017 City Application Clive Police Department Civil Service Packet 2017 Clive Police Department Applicant Check List Background/Polygraph Consent Wavier Release of Information Waiver (Obtain Records) Police

More information

COUNTY OF STANISLAUS

COUNTY OF STANISLAUS COUNTY OF STANISLAUS Commercial Cannabis Business Background Application 1010 10 TH Street Modesto, CA 95354 cannabis@stancounty.com Name as Shown On Application Page 1 of 2 COMMERCIAL CANNABIS BUSINESS

More information

Cobb County Sheriff s Office Employment Application - Sworn

Cobb County Sheriff s Office Employment Application - Sworn Cobb County Sheriff s Office Employment Application - Sworn Sheriff s Office Recruiting Office 770-499-4616 770-499-4745 Applicant s Name: This application is the basis for the employment screening process

More information

STATE OF NEW JERSEY DEPARTMENT OF HEALTH AND SENIOR SERVICES

STATE OF NEW JERSEY DEPARTMENT OF HEALTH AND SENIOR SERVICES STATE OF NEW JERSEY DEPARTMENT OF HEALTH AND SENIOR SERVICES PERSONAL HISTORY DISCLOSURE FORM FORM 2 PERSONAL HISTORY DISCLOSURE FORM 2 INSTRUCTIONS PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING

More information

ALABAMA DENTAL HYGIENE BOARD EXAM LICENSURE APPLICATION

ALABAMA DENTAL HYGIENE BOARD EXAM LICENSURE APPLICATION ALABAMA DENTAL HYGIENE BOARD EXAM LICENSURE APPLICATION 1. An unmounted passport photograph, 2x2, of applicant taken not more than six months before date of application, must be securely pasted, NOT STAPLED,

More information

APPLICATION FOR INITIAL LICENSE

APPLICATION FOR INITIAL LICENSE South Carolina Department of Labor, Licensing and Regulation South Carolina Board of Examiners in Speech-Language Pathology and Audiology P.O. Box 11329 Columbia, SC 29211 Phone: 803-896-4655 Fax: 803-896-4719

More information