Student Application for

Transcription

1 PLEASE PRINT THIS FORM, COMPLETE AND RETURN TO THE NORTHERN ARIZONA UNIVERSITY POLICE DEPARTMENT Student Application for Document Imaging Specialist Document Imaging Internship (Please check the box to indicate the position you are applying for.) By filling out the document you certify that all details are correct and accurate to the best of your ability. In submitting this application you are submitting a legal document to the Northern Arizona University Police Department. The information inside may be subject to confirmation and can lead to disqualification if found to be false.

2 Northern Arizona University Police Department Student Document Imaging Specialist STANDARDS FOR EMPLOYMENT 1. Must be a full-time NAU student with a minimum of 1 semesters remaining. 2. Must be a minimum of 18 years of age. 3. Must be able to work hours a week. 4. Must be able to perform the duties and job functions of a Student Document Imaging Specialist 5. Must possess a high degree of personal integrity and ethics. 6. Shall not have been convicted of a felony, or any offense that would be considered a felony if committed in Arizona, or exhibit a pattern of behavior that reflects a disregard for rules, regulations, or laws. 7. Shall not have been dishonorably discharged from the United States Armed Forces. 8. Shall not have illegally sold, produced, cultivated, or transported marijuana, dangerous drugs or narcotics for sale. 9. Shall not have illegally used dangerous drugs or narcotics (other than marijuana) for any purpose within the past 24 months. 10. If under 21 years of age, shall not exhibit a pattern of behavior that reflects a disregard for rules, regulations, laws, or substance abuse (alcohol/drugs). 11. Shall not have been convicted of, or adjudged, to have violated traffic regulations governing movement of vehicles with such a frequency so as to indicate disrespect for traffic laws and a disregard for the safety of other persons on any roadway. 12. An educational deferral/referral for any issue will be reviewed on a case by case basis.

3 Northern Arizona University Police Department Student Document Imaging Specialist Application PERSONAL INFORMATION Name: Date: SSN: When Can You Begin: Current (local) Address: Permanent Address: City: State: Zip Code: Address: EDUCATIONAL HISTORY Year in School at NAU: Credit Hours (this semester): Anticipated Graduation Date: Major: High School: Graduation Date: City: State: REFERENCES Please list at least two references who have known you well during the past five years and are NOT family members or past employers. Name: Relationship: Name: Relationship: Name: Relationship: RESIDENTIAL HISTORY Please list ALL residences for the past five years (attach separate sheet if necessary).

4 EMPLOYMENT HISTORY Please list all employment, starting with the most recent first (attach separate sheet if necessary). Employer: Dates of Employment (from/to): May we contact? Address: Job Title: Supervisor: Job Responsibilities: Reason for Leaving: Employer: Dates of Employment (from/to): May we contact? Address: Job Title: Supervisor: Job Responsibilities: Reason for Leaving: Employer: Dates of Employment (from/to): May we contact? Address: Job Title: Supervisor: Job Responsibilities: Reason for Leaving: Do you currently, or have you ever worked in ANY capacity for NAU: Yes / No If yes, what department? Special skills / qualifications / interests): I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT AND ACCURATE, AND IN SUBMITTING THIS APPLICATION, I UNDERSTAND THAT FALSE STATEMENTS MAY DISQUALIFY ME FOR EMPLOYMENT OR CAUSE MY SUBSEQUENT DISMISSAL. I AUTHORIZE THE NORTHERN ARIZONA UNIVERSITY POLICE DEPARTMENT TO CONDUCT A BACKGROUND INVESTIGATION THROUGH ANY AND ALL LAW ENFORCEMENT AGANCIES OF THE PLACES WHERE I HAVE RESIDED. Print Full Name Signature Date

5 Northern Arizona University Police Department Personal History Questionnaire Name: Date: Answer the following questions to the best of your ability. Answering yes to any of the following questions does not necessarily disqualify you from the selection process. Attach an additional sheet to this application if necessary to explain circumstances. CRIMINAL CONDUCT 1. Have you ever been arrested for a criminal offense? If yes what for? 2. Have you ever been convicted of any crime? If yes, what crime? 3. Have you ever been on probation? If yes what for? 4. Have you ever taken part in any crime that would be a considered a felony in Arizona? 5. Have you ever knowingly been in possession of, bought, or sold stolen property? DRIVING HISTORY 1. Have you ever been involved in any unreported accident or hit and run accident, other than as a victim? 2. Has your diver s license ever been suspended or revoked? If yes what for? 3. Have you ever driven while intoxicated or under the influence of any drug or narcotic? 4. Have you ever been cited for a traffic violation? If yes what violation(s)?

6 ALCOHOL/DRUG HISTORY 1. If under 21 years of age, when was the last time you consumed alcohol? Under what circumstances? How many times in the past 6 months? 2. Have you ever used or experimented with any illegal drug including marijuana, or narcotics? What substances and how many times each? 3. Have you ever bought, sold, transported, grown, or cultivated any illegal drug or narcotics? 4. Do you associate with or live with anyone who uses or possesses any illegal drug including marijuana or narcotics? 5. When was the ABSOLUTE last time you tried marijuana or other illegal drug? MILITARY HISTORY 1. Have you ever served in the military, armed forces, reserve, or national guard? If yes, a. Dates of service: b. Branch : c. Type of Discharge: EMPLOYMENT HISTORY/HONESTY 1. Have you ever stolen any money or property from a place you worked at? If yes, what? 2. Have you ever deliberately damaged an employer s property? 3. Have you been fired or asked to resign from any employment? If yes, what were the circumstances? 4. Did you leave any jobs off your application? ALL APPLICANTS 1. Did you understand all of the above questions? 2. Did you answer all questions truthfully? SIGNATURE: DATE:

7 Computer Skills Questionnaire Please use the space provided to describe your knowledge, skills, and abilities related to computers. Don t forget to mention any specific software you are familiar with and your proficiency level. Please use black ink and legible handwriting. 1. Please rate your general computer proficiency: o None o Basic (browse internet, check , complete basic documents) o Intermediate (uses advanced software features) o Advanced (programming, IT related certificates) 2. Which of the following computing tasks do you have experience with? o Basic Scanning o Document Imaging o Data Entry o File System Management 3. Do you have experience with any of the following software products? If so, please indicate your proficiency level (B-Basic, I-Intermediate, A-Advanced). Windows 7 Enterprise Edition Kofax Express Desktop Intergraph I/LEADS RMS Microsoft Excel Microsoft Access 4. Describe any other computer experience you have. Include any coursework you have taken, particular applications you have experience with, or certifications you hold. Print Full Name Signature Date