DENVER CITY POLICE DEPARTMENT

Transcription

1 **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 (806) APPLICANT INFORMATION Duties include but are not limited to: Police Officers serve the citizens of Denver City by providing preventive patrols, enforcement of criminal and traffic laws, investigation of reported crimes, and response to calls-for-service. Police Officers are also required to participate in community originated policing activities. QUALIFICATIONS Minimum 21 years old Valid Texas driver's license Good driving record and no DUIDWI arrests High School graduate or GED U.S. Citizen or an alien authorized to work in the United States No felony convictions or on probation for other crimes Never convicted of any offense resulting from Family Violence Honorable Military discharge, if applicable Must be able to pass Physical & Psychological examinations Must agree to a complete personal background investigation Must be a certified Texas Peace Officer OTHER REQUIREMENTS Must be able to respond (on scene) within 15 minutes of call out Must live 5 miles of Denver City to qualify for a take home vehicle Must have local telephone service (Cellular phone only, will not be enough) Must complete a written application and oral interview BENEFITS Starting Salary $ bi-weekly Paid life and medical insurance on employee Ten (10) paid holidays per year Two (2) weeks paid vacation after one (1) year of service Nine (9) days sick leave per year TMRS - State Retirement System UNIFORMS and most accessories provided (handgun not provided) [ have read and understand the above information. Signature Date

2 APPLICATION FOR EMPLOYMENT (PRE-EMPLOYMENT QUESTIONARE) (AN EQUAL OPPORTUNITY EMPLOYER) PERSONAL INFORMATION DATE DRIVER'S LICENSE #_ LAST FIRST SOCIAL SECURITY* MIDDLE PRESENT ADDRESS STREET CITY STATE ZIP PERMANENT ADDRESS STREET CITY STATE ZIP PHONE _ARE YOU 18 YEARS OR OLDER? YES NO [~] ARE YOU EITHER A U.S. CITIZEN OR AN ALIEN AUTHORIZED TO WORK IN THE UNITED STATES? YES NO EMPLOYMENT DESIRED POSITION ARE YOU CURRENTLY EMPLOYED? SALARY DESIRED DATE YOU CAN START IF SO MAY WE INQUIRE OF YOUR PRESENT EMPLOYER? HAVE YOU EVER APPLIED TO THIS COMPANY BEFORE? WHEN? WHAT POSITION HOW DID YOU LEARN OF THIS POSITION? EDUCATION AND LOCATION OF SCHOOL NO. OF YEARS ATTENDED DID YOU GRADUATE? SUBJECTS STUDIED GRAMMAR SCHOOL HIGH SCHOOL COLLEGE TRADE.BUSINESS OR CORRESPONDENCE SCHOOL GENERAL SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK: (PROVIDE TCLEOSE CERTIFICATES WHERE APPLICABLE) SPECIAL SKILLS: ACTIVITIES: (CIVIC, ATHLETIC, ETC) EXCLUDE ORGANIZATIONS, THE OF WHICH INDICATES THE RACE, CREED, SEX, AGE, MARITAL STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS US MILITARY OR NAVAL SERVICE RANK PRESENT MEMBERSHIP IN NATIONAL GUARD OR RESERVES

3 FORMER EMPLOYERS (LIST BELOW LAST FIVE EMPLOYERS, STARTING WITH LAST ONE FIRST). DATE: MONTH AND YEAR AND ADDRESS OF EMPLOYER PHONE NUMBER SALARY POSITION SUPERVISOR REASON FOR LEAVING WHICH ONE OF THESE JOBS DID YOU LIKE BEST? WHAT DID YOU LIKE MOST ABOUT THIS JOB? ; REFERENCES: GIVE THE S OF FIVE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR. ADDRESS & PHONE NUMBER BUSINESS & BUSINESS PHONE # YEARS AQUAINTED rn C. ASF. OF EMERGENCY NOTIFY: ADDRESS TELEPHONE

4 "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 an> and all information concerning my previous employment and any pertinent information they may have, 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 prior notice and without cause. Date _Signature_ DO NOT WRITE BELOW THIS LINE INTERVIEWED BY: DATE: 20 REMARKS: NEATNESS: HIRED: ABILITY: D YES D NO POSITION: DEPT: SALARYWAGE: DATE REPORTING TO WORK: APPROVED: EMPLOYMENT MANAGER DEPARTMENT HEAD 3. GENERAL MANAGER

5 IACK D. MILLER CHIEF OF POLICE DENVER CITY POLICE DEPARTMENT P.O. DRAWER 1539 DENVER CITY, TEXAS (806) AUTHORIZATION TO RELEASE INFORMATION SOCIAL SECURITY NO. ADDRESS DATE OF BIRTH TELEPHONE NO. To Whom It May Concern: I am an applicant for a position with the Denver City 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. It is in the public's interest that all relevant information concerning my personal and employment history be disclosed to the Denver City Police Department. I authorize the disclosure and release of any and all information that you may have concerning me, including information of a confidential or privileged nature, or any data or material which may have been sealed or agreed to be withheld pursuant to any prior agreement or court proceeding involving disciplinary matters. This includes, but is not limited to, the release of employment files; personnel records; background investigation files; disciplinary records; any and all internal affairs investigations, complaints or grievances filed by or against me, training files, arrest, criminal, probation and driving records; polygraph, and psychological examinations, opinions, and evaluations; military, financial, credit, academic or other records. This also includes photocopies of the above material. I hereby release you, your organization, their agents and representatives, and any person furnishing information from any and all liability and or damage which may result from furnishing this information. This waiver is valid for a period of one year from the date of my signature. A photocopy or FAX copy of this release form will be valid as an original thereof, even though the said photocopy or FAX copy does not contain an original writing of my signature. Should there be any questions as to the validity of this release, you may contact me at the address or telephone number listed on this form. Signature Date_ Before me, the undersigned Notary Public, personally appeared,. known to me to be the person whose name is subscribed to the forgoing instrument and acknowledged to me that heshe signed and executed the same. Subscribed and Sworn to before me this day of _, 20 Notary Public in and for Tho State of Texas My Commission Expires On:!!THTS FORM MUST BE NOTARIZED OR IT WILL NOT BE ACCEPTED!!