INSTRUCTIONS FOR COMPLETING APPLICATION

Transcription

1 KISSIMMEE POLICE DEPARTMENT 8 N. Stewart Avenue Kissimmee, Florida (407) Volunteer Application EQUAL OPPORTUNITY EMPLOYER The City of Kissimmee does not discriminate on the basis of race, religion, color, sex, age, national origin, or disability. NAME (last, first, middle): ADDRESS: PHONE: SOCIAL SECURITY #: INSTRUCTIONS FOR COMPLETING APPLICATION Please complete all portions of this application fully and accurately or your processing may be delayed or stopped. If an item does not apply to you, write in the letters N/A for not applicable. The application must be completed by the candidate only and must be notarized as indicated. As part of the processing for a volunteer position with the Kissimmee Police Department, a criminal history check will be conducted, and misrepresentation of any information is sufficient cause for rejection or dismissal. The background investigation will verify information provided. 1. APPLICANT CHECKLIST Along with your application, please submit copies of the documents listed below. Drivers License /Identification Card Birth Certificate Social Security Card Proof of legal name change, if applicable. (Marriage Certificate, Dissolution of Marriage Certificate, etc.) 1

2 2. PERSONAL INFORMATION Date of Birth: / / Sex: Race: (To be used for statistical data, affirmative action, & criminal history use.) List all other names you have used, including maiden names & nicknames. Are you a U.S. citizen? Yes No If no, are you a naturalized citizen? Yes No If yes, certification number: Have you ever worked for or applied to the Kissimmee Police Department before? Yes No If yes, state position worked or applied for: Date: Is there any language (other than English) you can read, write, and speak fluently? Yes No Languages: Qualifications: List any skills you have that would help you in this position such as computer, driving, clerical, etc. 3. MILITARY Have you ever been a member of the United States Armed Forces? Yes No If yes, attach a copy of your DD214 to your application. Have you ever been disciplined or received an Article 15 while in the military? Yes No If yes, list each discipline, dates and outcome on a separate sheet of paper and attach to the application. 2

3 4. EMPLOYMENT Current Employer: Dates of Employment: From: To: Address: City: State: Zip Code: Position Held: Supervisor: Phone #: Type of Business: May we contact your present employer? Yes No If you state no and any offers are made, we may contact your current employer at that time? Yes No 5 RESIDENCES List chronologically all of your residences for the past five years, beginning with the most recent. (Use additional sheets if necessary.) Present Address: City: State: Zip Code: Rent Own Parent s Residence: Yes No From: To: If you checked Rent, complete the section below: Complex Name: Landlord s Name: Complete address: Former Address: City: State: Zip Code: Rent Own Parent s Residence: Yes No From: To: 3

4 If you checked Rent, complete the section below: Complex Name: Landlord s Name: Complete address: Former Address: City: State: Zip Code: Rent Own Parent s Residence: Yes No From: To: If you checked Rent, complete the section below: Complex Name: Landlord s Name: Complete address: 6. PERSONAL REFERENCES List three personal references you have known for at least five years such as chaplain, pastor, friends, and former employers. Do not list relatives. Name: Complete Address: Home Phone: Known for How Long: Work Phone: Relationship: Name: Complete Address: Home Phone: Known for How Long: Work Phone: Relationship: 4

5 Name: Complete Address: Home Phone: Known for How Long: Work Phone: Relationship: 7. DRIVERS LICENSE INFORMATION Please provide the following information. Driver s License Number: State: Type: Expiration Date: 8. CRIMINAL/TRAFFIC HISTORY NOTE: Because you are applying to a law enforcement agency, you must include information about any arrest, conviction, or other criminal activity, even if the records are sealed or expunged. If you answer yes to any of the following, please give details. Have you ever been arrested, charged, or convicted of any felony and/or misdemeanor? Yes No Please list city, state, year, charge and outcome on a separate sheet of paper and attach to application. Are you presently under any criminal investigation? Yes No Have you ever been involved in any criminal activity? Yes No Have you ever used illegal drugs? Yes No If yes, specify type, usage and when used: Have you ever been involved in the sale or cultivation of illegal drugs? Yes No Have you ever taken anything from an employer without permission? Yes No 5

6 Have you ever been or associated with anyone belonging to any organization, past or present, which would place the integrity of the Kissimmee Police Department in question? (e.g., KKK, Nazi organization, gang member, organized crime?) Yes No If yes, list organization: Do you now or have you ever had regular associations with persons whom you knew, or should have known, were under criminal investigation or indictment, or who have a reputation in the community or with law enforcement agencies for involvement in criminal behavior? Yes No 9. BACKGROUND INVESTIGATION WAIVER Please read and sign. POLICY STATEMENT: It is the policy of the Kissimmee Police Department to recruit qualified individuals from all segments of the work force. In pursuing this goal, a background investigation of each candidate is conducted with respect to factors that may have a bearing upon the applicant s job performance or which measure job capability. It is impossible to state all relevant and material factors necessary for a complete background investigation. In each case, the Department will consider whether the candidate s background makes him/her the best suited candidate. The circumstances underlying any negative findings will be considered as they relate to the candidate s ability to perform the particular volunteer assignment for which he/she is applying. FELONY/MISDEMEANOR CONVICTIONS: Any individual convicted of a felony or any misdemeanor crime involving moral character, false statement, or perjury will be precluded from service with the Kissimmee Police Department. With respect to all other criminal convictions which are not felonies, in each case the Department will consider whether the prior criminal conviction or military offense conviction will have a bearing on the applicant s qualifications or suitability for the volunteer assignment for which he/she is applying. The date and nature of the offense, the requirements of the position sought, as well as other qualifications, will be evaluated. PUBLIC RECORDS: During the selection and placement process, it will be necessary to inform the appropriate persons participating in the selection process of your record. Pursuant to Florida Statute 119, the Public Records Act, documents made or received by the Kissimmee Police Department in the course of processing the application may be public record and open for inspection by the public. Some records, such as examination questions and answers and medical documentation are not public records and may not be disclosed. Medical documentation may only be released with the written consent of the applicant. 6

7 REAPPLICATION: The Kissimmee Police Department allows for reapplication, retesting, and reevaluation of candidates not selected. THIS DOES NOT INCLUDE CANDIDATES WHOSE HISTORY INDICATES THE FOLLOWING: UNFITNESS FOR DUTY; UNTRUTHFULNESS DURING THE INITIAL APPLICATION PROCESS; NOT FULFILLING STATE MANDATED REQUIREMENTS. Applicants must wait one year, provided that a vacancy exists at that time, and must go through the entire testing/evaluation process with each reapplication. I have read and understand the above policies. All the information that I have provided is true and accurate to the best of my knowledge. I further understand that any omissions or inaccurate information will be grounds for me not to be selected or be released from my position. Signature: Date: 7

8 10. RELEASE OF INFORMATION Please sign in the presence of a Notary. Applicant: Please read carefully before signing this form. If you have questions regarding the following statement or any questions about the information contained in this application, please contact the Kissimmee Police Department, Volunteer Coordinator, before signing. I respectfully request and authorize you to furnish the Kissimmee Police Department any and all information that you may have concerning my work record, personal background, civil/criminal records, military records and driver s license history/driving information. This information is to be used to assist in determining my qualification and suitability for the position I am seeking with the Kissimmee Police Department. I hereby release you, your organization and all others from any liability or damage which may result from furnishing the information requested. I understand that any information obtained during a personal history background investigation which is developed directly or indirectly, in whole or in part, upon this release authorization will be considered in determining my suitability for employment by the Kissimmee Police Department. Name: Date of Birth: Social Security #: Signature: Applicant will sign in the presence of a Notary Public. (Notary Public) Before me, personally appeared who says that they have executed this authorization of their own free will and with full knowledge of its purpose. Sworn to and subscribed before me, this: day of, 20 Type, print or stamp Commissioned name of Notary My commission expires: Personally Known Produced Identification Type of Identification produced: Notary s Signature: 8

9 11. FINGERPRINT RELEASE Please fill out the form completely, print clearly and bring your photo identification. Date: Social Security #: Name (last, first, middle): Street Address: City: State: Date of Birth: Sex: Zip Code: Race: Height: Weight: Hair: Eyes: Place of Birth (City, State): REASON PRINTED: Law Enforcement FSS Position applying for: VOLUNTEER Signature of Applicant: X PRINT CERTIFICATION To be completed by the official taking fingerprints. Date: Employee s name (first, last): ID#: (Print) This is to certify that the above named applicant has been fingerprinted on this date. Employee taking fingerprints signature: NOTE: This certification must be returned to the Background Investigator. For use by the Volunteer Coordinator: Date Received: Date Fingerprints Sent: Results Received: 9

10 THIS AREA FOR BACKGROUND INVESTIGATORS USE ONLY Release of information attached: Yes No Military: Yes No DD214 Attached Yes No Military Records Requested Request Received Personal References #1 Contacted Yes No Form Attached Yes No #2 Contacted Yes No Form Attached Yes No #3 Contacted Yes No Form Attached Yes No Drivers License Information Driver s License: Valid Not Valid Driver s License Type: Expiration: Checked by: Criminal History FCIC: Negative History Checked by: NCIC: Negative History Checked by: Local: Negative History Checked by: Fingerprint Information Fingerprints Received: Yes No Fingerprints Sent Fingerprint Information Received Background Investigator ID 10