NIPSTA: *Registration MUST be completed at least three days prior to desired POWER test date.

Similar documents
Village of Lisle Police Department

Public Safety Recruitment 1127 S. Mannheim Rd., #203 Westchester, IL HIRE

Village of Stickney Police Department

Village of Johnsburg Police Department

Public Safety Recruitment 1127 S. Mannheim Rd., #203 Westchester, IL HIRE

Public Safety Recruitment 1127 S. Mannheim Rd., #203 Westchester, IL HIRE

VILLAGE OF THORNTON POLICE DEPARTMENT

Public Safety Recruitment 1127 S. Mannheim Rd., #203 Westchester, IL HIRE

V I L L A G E O F R I C H T O N P A R K P O L I C E D E P A R T M E N T

City of Princeton Fire Department Firefighter/EMT-I

Police Officer Minimum Requirements

Please visit our website to pay the application fee, complete the online application and download all release forms:

FIREFIGHTER. Public Safety Recruitment 1127 S. Mannheim Road, #203 Westchester, IL

City of Mattoon Fire Department

CITY OF CHAMPAIGN POLICE DEPARTMENT POLICE OFFICER HIRING PROCESS

CITY OF DIXON FIRE DEPARTMENT

City of Painesville Police Department

City of Painesville Police Department

Village of Arlington Heights Fire Department

City of Mattoon Fire Department Application Instructions

Police Officer Minimum Requirements:

Village of Skokie Public Safety Employment Application. Village of Skokie Authorization for Release of Personal Information Agreement

Thank you for your interest in the City of Plano, Illinois, Police Department. You

City of Des Plaines Fire Department Application Instructions

Public Safety Recruitment 1127 S. Mannheim Rd., #203 Westchester, IL HIRE

Public Safety Recruitment 1127 S. Mannheim Rd., #203 Westchester, IL HIRE

IMPORTANT INFORMATION READ CAREFULLY

Announces an Examination for POLICE RECRUIT

Application for Employment

Michelle Hayes Assistant Superintendent Personnel Services

PERSONAL DATA Last Name First Middle Social Security No.

Bullhead City Police Department Explorer Application Instructions

NC General Statutes - Chapter 163 Article 20 1

Clive Police Department Civil Service Packet 2017

EMPLOYMENT APPLICATION

Nova Scotia Nominee Program NSNP 100 Application Form for the Principal Applicant

HOUSE BILL 589: VIVA

IMMIGRATION Canada. Study Permit. Dakar Visa Office Instructions. Table of Contents IMM 5826 E ( ) Document Checklist Study Permit

Hardee County Board of County Commissioners Equal Employment Opportunity (EEO) Self-Identification Form (completion of this form is voluntary)

NC General Statutes - Chapter 163A Article 21 1

Application Guide: Ontario s Express Entry French- Speaking Skilled Worker Stream

LOS ANGELES POLICE DEPARTMENT Personal History Form for Police Officer Applicants

APPLICATION FOR DENTAL HYGIENE/ PROVISIONAL LICENSURE

ILLINOIS STATE POLICE MERIT BOARD

Labour Impact Category

Occupational License Application

APPLICATION INSTRUCTIONS FOR PRACTISING CERTIFIED DENTAL ASSISTANT

CERTIFIED DENTAL ASSISTANT APPLICATION INSTRUCTIONS FOR TEMPORARY CERTIFICATION

Driver License Checklist Texas

GARDENA POLICE DEPARTMENT

UOCAVA Voters Uniformed Services and Overseas Absentee Voters

IMMIGRATION Canada. Temporary Resident Visa. Singapore visa office instructions. Table of Contents IMM 5890 E ( )

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

Employment Application City of Fergus Falls ~ 112 West Washington ~ Fergus Falls, MN ~ Phone (218)

Keokuk Police Department

LIVINGSTON COUNTY SHERIFF DEPARTMENT

APPLICATION FOR DENTAL HYGIENE/ PROVISIONAL LICENSURE

APPLICATION FOR EMPLOYMENT

APPLICATION FOR CERTIFICATION AS A BIOLOGICAL WASTEWATER TREATMENT OPERATOR

JOB CORPS ELIGIBILITY AND ADDITIONAL SELECTION CRITERIA AND DOCUMENTATION REQUIREMENTS

APPLICATION FOR EMPLOYMENT

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

LAKE COUNTY ETHICS ORDINANCE

APPLICATION FOR DENTAL/PROVISIONAL LICENSURE

STATE OF KANSAS OFFICE OF THE ATTORNEY GENERAL Through the KANSAS BUREAU OF INVESTIGATION INSTRUCTIONS

GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2017 H 2 HOUSE BILL 843 Committee Substitute Favorable 4/26/17

As Introduced. 132nd General Assembly Regular Session H. B. No

As Reported by the House Transportation and Public Safety Committee. 132nd General Assembly Regular Session Sub. H. B. No.

CITY OF WATERBURY HUMAN RESOURCES DEPARTMENT

APPLICATION FOR INITIAL LICENSE

Income Guidelines Family Size MINIMUM Family Size MINIMUM

EMPLOYMENT APPLICATION

Job s Daughters International

Salt Lake City Civil Service Commission Rules and Regulations

Guide for the New Brunswick Provincial Nominee Program Express Entry Category: New Brunswick Labour Market Stream

CITY OF CHICAGO ECONOMIC DISCLOSURE STATEMENT and AFFIDAVIT Related to Contract/Amendment/Solicitation EDS # 24909

COUNTY OF VENTURA VENTURA COUNTY SHERIFF S OFFICE LICENSE TO CARRY WEAPONS POLICY

EXAM APPLICATION FOR REAL ESTATE

RESTORATION OF FIREARM RIGHTS

YOCHA DEHE TRIBAL GAMING AGENCY GAMING LICENSE APPLICATION

ALABAMA STATE BOARD OF CHIROPRACTIC EXAMINERS ADMINISTRATIVE CODE CHAPTER 190-X-2 LICENSURE TABLE OF CONTENTS

1 of 9. APPLICATION CHECKLIST - IMPORTANT - Submit all items on the checklist below with your application to ensure faster processing.

The Election Process: Roles & Responsibilities

Instructor Information for Endorsement

Jon Husted Ohio Secretary of State. Voter Access Guide For Voters with Disabilities. ADA Coordinator s Office. Local: (614)

ARKANSAS SECRETARY OF STATE. Rules on Verification of Voter Registration Cards

ARKANSAS STATE POLICE PRIVATE BUSINESS RECOGNITION APPLICATION

Application Guide For Ontario French- Speaking Skilled Worker Stream

To qualify for a Chicago CityKey, you must be a resident of Chicago and meet the following document criteria:

Completing the Florida Legislature Employment Application

Nova Scotia Nominee Program NSNP 100 Application Form for the Principal Applicant

WHEREAS, the parties are desirous of further amending said agreement,

TOWN OF LAKEVIEW CHIEF OF POLICE APPLICATION

Minimum Standards for Employment as a Law Enforcement Office

A BASIC GUIDE TO LOBBYING REGISTRATION AND DISCLOSURE IN THE CITY OF IRVINE. Prepared by the City Clerk March 2006 Updated January 2018

Form PPPR 8 Application for appointment of welfare guardian Section 12, Protection of Personal and Property Rights Act 1988

2016 Statewide Primary and General Election:

COUNCIL ROCK SCHOOL DISTRICT SUPERINTENDENT'S EMPLOYMENT AGREEMENT. THIS AGREEMENT dated this 7th day of May 2015, between the Council Rock

REMISSION OF FINE NOTICE TO APPLICANT. Failure to comply with instructions will delay processing.

Form PPPR 11 Application for property order Section 31, Protection of Personal and Property Rights Act 1988

Transcription:

Public Safety Recruitment 1127 S. Mannheim Rd., #203 Westchester, IL 60154 1-800-343-HIRE www.publicsafetyrecruitment.com Village of Plainfield Police Department Police Officer Minimum Requirements Thank you for your interest in the Village of Plainfield Police Department. Please read this document carefully, paying particular attention to deadlines and required documents: $25 non-refundable application fee; U.S. Citizen; No felony convictions; High school diploma or equivalent; Associate s Degree in Criminal Justice or Law Enforcement OR a Bachelor s Degree in any field from a regionally accredited college or university; Valid driver s license; Must be 21 to under 35 years of age as of application deadline, unless otherwise exempt by statute; Must have a valid NIPSTA POWER Test Card PRIOR to Oral Interviews. NIPSTA POWER test card must be issued between January 1, 2011 and October 31, 2011 to be considered valid. More information regarding NIPSTA provided below and under Application Instructions on the next page; Military Service Record/Discharge DD-214 (if applicable); Testing Requirements: Candidates must achieve at least a 75% to pass the written examination and at least a 75% to pass the oral interview. The top 40 candidates from the written exam will move on to oral interviews (see application instructions for more information); The Village of Plainfield will no longer consider members of the immediate family of current employees of the Village for employment. For the purpose of clarification, immediate family is defined by blood or marriage as spouse, parent, child, grandparent, grandchild, brother, sister, uncle, aunt, first cousin, step-parent, step-brother, step-sister, step-son, step-daughter, niece, nephew, mother-in-law, father-in-law, sister-in-law, and brother-in-law. NIPSTA: 2300 Patriot Blvd., Glenview, IL 60026 *To register for the POWER Test visit http://www.nipsta.org/power OR call (847) 998-8090 POWER Test dates available (as of 07/28/2011): ~August 13, 2011 ~September 17, 2011 ~October 15, 2011 *Registration MUST be completed at least three days prior to desired POWER test date. Please visit our website to pay the application fee and complete the online application www.publicsafetyrecruitment.com. If you have any questions, please contact Public Safety Recruitment 1-800-343-HIRE ~ e-mail: info@publicsafetyrecruitment.com 9 am 5 pm Monday through Thursday and 9 am 3 pm on Friday

Village of Plainfield Police Department Application Instructions Public Safety Recruitment 1127 S. Mannheim Rd., #203 Westchester, IL 60154 1-800-343-HIRE www.publicsafetyrecruitment.com 1) Visit www.publicsafetyrecruitment.com to complete the online application for the position of Police Officer. Applications must be completed and confirmed online by 12 noon on Friday, September 9, 2011. You will receive a confirmation number when your application is complete; save this number for your records. 2) Return signed release forms and requested documents (see checklist) to Public Safety Recruitment, Attn.: Plainfield PD, 1127 S. Mannheim Rd, Ste. 203, Westchester, IL 60154, BEFORE 12 noon on Friday, September 9, 2011. Applications received after 12 noon on 9/9/2011 will not be accepted. Faxed release forms will not be accepted. Sending release forms and other required documents via traceable carrier (i.e. FedEx, UPS, Certified Mail, etc.) is suggested to ensure timely delivery. Documents may also be delivered by hand to Public Safety Recruitment during business hours. Public Safety Recruitment is not responsible for late or lost documents. It is the responsibility of the candidate to ensure all paper work is submitted properly by the deadline date. 3) Applicants must submit proof that they have passed the Illinois Peace Officer Wellness Evaluation Report (POWER) Test at the Northeastern Illinois Public Safety Training Academy (NIPSTA) within 10 months prior to Oral Interviews (1/1/2011 10/31/2011). Candidates testing after 9/9/2011 must submit proof of POWER test registration in place of POWER test card. A copy of the valid POWER test card must be submitted to Public Safety Recruitment after POWER test date. Registration for the POWER test MUST be completed at least three days prior to the selected POWER Test session date. For more information, contact NIPSTA at (847)998-8090 or visit http://www.nipsta.org/power. Proof of POWER test card will be collected prior to oral interviews. 4) Attend Orientation and Written Exam on Saturday, October 1, 2011 at the Law Enforcement Center, 14300 S. Coil Plus Drive, Plainfield, IL 60544. Candidates must arrive by 8:15 a.m. with photo identification to sign in. Orientation will begin promptly at 9:00 a.m. and testing will immediately follow. Candidates arriving late will NOT be permitted to test. 5) The top 40 candidates who achieve the highest scores on the written exam will be invited to participate in the oral interview process. Applicants must obtain a score of at least 75% on the written examination to be placed on an Initial Eligibility Register (IER). Candidates will have 10 days after posting to have educational and military preference points added. The IER will be valid for two years. The top 40 candidates from the finalized IER will be scheduled for the oral interview phase. Those passing with a score of at least 75% will be placed on the Primary Eligibility Register (PER) in rank order. Rank order is based upon the candidate s total cumulative score (written test multiplied by 60% plus oral interview multiplied by 40%). In the event that this Primary Eligibility Register is exhausted within a two year time frame, the Police Board may establish a new PER from the remaining candidates on the Initial Eligibility Register. All portions of the testing process are mandatory. Failure to attend and successfully complete any portion of the process will result in elimination from employment consideration. Please visit our website to pay the application fee and complete the online application www.publicsafetyrecruitment.com. If you have any questions, please contact Public Safety Recruitment 1-800-343-HIRE ~ e-mail: info@publicsafetyrecruitment.com 9 am 5 pm Monday through Thursday and 9 am 3 pm on Friday

Application: Confirmed online Release Forms: CHECK LIST: PLAINFIELD POLICE DEPARTMENT *No photocopies or fax copies will be accepted. You must submit the ORIGINAL DOCUMENTS WITH ORIGINAL SIGNATURES. Acceptable witness signatures include adult family members and friends. DEADLINE: 9/9/2011 at Noon WRITE CONFIRMATION NUMBER HERE: (The confirmation page immediately follows the references section of the online application) Alcohol, Drug and Substance Abuse Screening* Behavior Profile* Credit History* Criminal History Information/ Fingerprint* Driving Record* Employment Past and Present* DEADLINE: 9/9/2011 at Noon High School, College, University* Diploma Medical Records* Personal Information Release to Municipality* Written Examination* Village of Plainfield Employment Agreement* Other required documents: DEADLINE: 9/9/2011 at NOON COPY of Official Certified College or University Transcripts ( Must indicate attainment of Associate s Degree in Criminal Justice or Law Enforcement or a Bachelor s Degree in any field from an accredited College or University. Photocopies are acceptable.) COPY High School Diploma or equivalent (Copy of High School Transcripts with Graduation Date, Dated GED, or Signed Letter on High School letterhead is acceptable.) COPY of valid NIPSTA POWER Test Card issued between 1/1/2011 and 10/31/2011 (Candidates testing after 9/9/2011 must submit proof of registration in place of POWER Test card. A copy of the valid POWER test card must be submitted to Public Safety Recruitment after POWER test date.) COPY valid Driver s License (Copy of front and back if you received a renewal sticker) COPY of Military Service/Discharge Record DD-214 (if applicable) COPY of Social Security Card COPY Birth Record: READ CAREFULLY: Must contain the applicant s full name and date of birth and must be verifiable. To be verifiable, it must be possible to contact the regulatory authority to confirm the authenticity of the document. ONE OF THE FOLLOWING IS ACCEPTABLE AND REQUIRED: Copy of US Birth certificate (Copy of original or certified by a Board of Health or Bureau of Vital statistics within the U.S. State Department or U.S. territories Hospital copy not accepted.) OR Copy of valid US Passport OR Copy of Naturalization Papers Applications will not be verified until after the deadline has passed. Candidates who submit applications lacking proper documentation as indicated above will not be admitted to orientation or testing and you will be eliminated from employment consideration. I/O Solutions is not responsible for late, misdirected or incomplete application submissions. You must submit all required documents and have successfully CONFIRMED your online application by the deadline in order to be eligible to attend any portion of testing. You may drop your application documents off in person or by mail; however, all documents including your online application are due by the deadline as indicated. PLEASE SUBMIT FORMS & OTHER REQUIRED DOCUMENTS TO: PUBLIC SAFETY RECRUITMENT ATTN: PLAINFIELD PD 1127 S. MANNHEIM RD., SUITE 203 WESTCHESTER, IL 60154 DO NOT SUBMIT REQUIRED DOCUMENTS TO THE DEPARTMENT OR VILLAGE OF PLAINFIELD.

Village of Plainfield Police Department Police Officer Benefit Package Information 4/30/2011 4/30/2012 Base Salary $53,100.00 $54,162.00 Complete Basic Training $55,728.00 $56,842.00 Holiday Pay (80 hours) $2,143.38 $2,186.23 Vacation (80 hours) $2,143.38 $2,186.23 Personal Leave (24 hours) $643.02 $655.87 Sick Leave (avg. 28 hours) $750.18 $765.18 Pension - 10.5% $5,851.44 $5,968.41 Uniform $2,200.00 $2,200.00 Vest $750.00 $750.00 Health Insurance (PPO2 Family) $18,530.16 $18,530.16 Vision $247.68 $247.68 Dental $943.56 $943.56 TOTAL ANNUAL BENEFITS $89,930.81 $91,275.32

LAST NAME. FIRST NAME..... SSN.. ALCOHOL, DRUG AND SUBSTANCE ABUSE SCREENING CONSENT I hereby consent for the Village of Plainfield or I/O Solutions, Inc., or either of its authorized representatives to collect blood, urine or saliva samples from me and to conduct other necessary medical tests to determine the presence in my body or use by me of alcohol, drugs or controlled substances. I understand that the presence of certain medications in my blood and/or urine may affect test results. To aid in the analysis of the test results I would like to inform the Village of Plainfield, I/O Solutions, Inc., and either of its authorized representatives that I have taken the following medications in the last seven (7) days: I understand that release of my medical records by this written authorization will results in disclosure of these test results. I hereby consent to the release of the test results and other relevant medical information to authorized representatives of the Village of Plainfield, the Village of Plainfield Board of Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives and assignees from any and all claims, demands, actions, fees and causes of action, suits at law, proceedings in equity, and liability that may arise by reason of the drug, alcohol and substance abuse screening or due to the disclosure of the test results as authorized herein by me. Copyright 2011, I/O Solutions, Inc. PLAINFIELD PD REQUIRED DOCUMENT: 1 OF 11

BEHAVIORAL PROFILE DISCLOSURE This is to inform you that in processing your application an investigation will be made whereby information is obtained from you which will be used for a Behavioral Profile. The tests, survey and interviews are designed to: measure your attitudes regarding drugs and alcohol, trustworthiness, and work; to predict your interpersonal skills, personality traits and motivations; and to predict your on the job mental abilities. CONSENT FOR BEHAVIORAL PROFILE I hereby grant my consent for the I/O Solutions, Inc., or its authorized representative to conduct the necessary interviews and administer the necessary examinations to determine my Behavioral Profile. I understand that release of the results of my Behavioral Profile by this written authorization will result in disclosure of those test and survey results. I hereby consent to the release of the test and survey results and other relevant information to authorized representatives of the I/O Solutions, Inc. for appropriate review and dissemination to those municipalities and/or Police Departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees may arise by reason of the Behavioral Profile or due to the disclosure of the test and survey results as authorized herein by me. In the event that I have a disability which will affect my ability to take any examination, I will so inform the I/O Solutions, Inc. prior to the administration of the examinations so that a reasonable accommodation can be made. I/O Solutions, Inc. reserves the right to require medical documentation concerning the need for the accommodation. Copyright 2011, I/O Solutions, Inc. PLAINFIELD PD REQUIRED DOCUMENT: 2 OF 11

CREDIT HISTORY DISCLOSURE This is to inform you that in processing your application an investigation will be made whereby information is obtained from private credit reporting agencies as to your credit history. This investigative consumer report includes, if applicable, information as to your character, general reputation, personal characteristics, and mode of living. You have the right to make a written request within a reasonable period of time to receive detailed information about the nature and scope of this investigation. CONSENT AND AUTHORIZATION TO INVESTIGATE CREDIT HISTORY I hereby authorize and consent to a thorough investigation of my past and present credit history and disclosure of the results of that investigation to third parties. I understand that release of my past and present credit records by this written authorization will result in the disclosure of those records. I understand that this investigative consumer report can include, if applicable, information as to my character, general reputation, personal characteristics, and mode of living. I hereby consent to the release of the results of the investigation of my credit history and other relevant information to authorized representatives of the Village of Plainfield or I/O Solutions, Inc. for appropriate review and dissemination to those municipalities and/or Police Departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. Police Commissioners and the I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees from any and all claims, demands, actions, fees and causes of action, suits at law, proceedings in equity, and liability that may arise by reason of the investigation of my past and present credit history and the disclosure of the results of that investigation as authorized by me. I waive the right to written notice required of any former employer pursuant to the Personnel Records Review Act, 820 ILCS 40/7(1). I also acknowledge that I have had the opportunity to discuss the importance of this waiver with legal counsel of my own choosing. Copyright 2011, I/O Solutions, Inc. PLAINFIELD PD REQUIRED DOCUMENT: 3 OF 11

CRIMINAL HISTORY INFORMATION / FINGERPRINT DISCLOSURE This is to inform you that in processing your application an investigation will be made whereby information is obtained from State and local law enforcement agencies for any reportable criminal history information concerning you using your fingerprints. This information can include a record of any convictions, which are required by statute to be collected and maintained by government agencies. I agree to be fingerprinted by the Village of Plainfield and acknowledge that these fingerprints will be used to investigate my criminal history and conviction record. I agree to and understand the release of the results of the investigation, to determine my criminal history information, will result in the disclosure of information concerning whatever criminal history exists regarding me to third parties. I hereby acknowledge the results of the investigation to determine my criminal history will be released to authorized representatives of the Village of Plainfield or I/O Solutions, Inc. for appropriate review and dissemination to those municipalities and/or Police Departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees may arise by reason of the investigation into my criminal history and the disclosure of any of that information. Copyright 2011, I/O Solutions, Inc. PLAINFIELD PD REQUIRED DOCUMENT: 4 OF 11

DRIVING RECORD DISCLOSURE This is to inform you that in processing your application an investigation will be made whereby information is obtained from the Secretary of State regarding your driving record. This information can include a record of your current driver's license issuance information (exclusive of information on judicial driving permits); convictions and orders entered revoking, suspending, or canceling your driver's license or privilege. I hereby acknowledge the results of the investigation of my driving record will be released to authorized representatives of the Village of Plainfield or I/O Solutions, Inc. for appropriate review and dissemination to those municipalities and/or Police Departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. Police Commissioners, and I/O Solutions, Inc. its directors, officers, staff, employees, agents, representatives, and assignees may arise by reason of the investigation into and the disclosure of my driving record. Copyright 2011, I/O Solutions, Inc. PLAINFIELD PD REQUIRED DOCUMENT: 5 OF 11

EMPLOYMENT: PAST AND PRESENT CONSENT I hereby consent to a thorough investigation of my past and present employment activities and agree to cooperate in such investigation. I hereby authorize my past and present employers to release the requested information and to comment on my work record. I understand that by this written authorization my past and present employment records will be disclosed to third parties. I hereby consent to the release of the results of the investigation into my past and present employment and other relevant information to authorized representatives of the Village of Plainfield and I/O Solutions, Inc. for appropriate review and dissemination to those municipalities and/or Police Departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees may arise by reason of the investigation of my past and present employment and the disclosure of the results of that investigation as authorized herein by me. Copyright 2011, I/O Solutions, Inc. PLAINFIELD PD REQUIRED DOCUMENT: 6 OF 11

HIGH SCHOOL, COLLEGE, UNIVERSITY DIPLOMA CONSENT I hereby consent to an investigation to determine the authenticity of my high school or General Education Diploma, college, or University diploma. I hereby authorize my secondary school or its equivalent to release such information regarding the authenticity of my high school (or its equivalent), college, or university diploma to representatives of the Village of Plainfield or I/O Solutions, Inc. I understand that by this written authorization that information gathered regarding the authenticity of my diploma or its equivalent will be disclosed to third parties. I hereby consent to the release of results of the investigation of the authenticity of my diploma or its equivalent to authorized representatives of the Village of Plainfield or to I/O Solutions, Inc. for appropriate review and dissemination to those municipalities and/or Police Departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees may arise by reason of the investigation of the authenticity of my high school (or its equivalent), college, or university diploma and the disclosure of the results of that investigation as authorized herein by me. Copyright 2011, I/O Solutions, Inc. PLAINFIELD PD REQUIRED DOCUMENT: 7 OF 11

MEDICAL RECORDS CONSENT I hereby consent for I/O Solutions, Inc., or its authorized representative to obtain my medical records from my primary physician for the period of time that my name appears on the Village of Plainfield s Final Eligibility List. I understand that release of my medical records by this written authorization will result in disclosure of my medical records. I hereby consent to the release of my medical records to authorized representatives of the Village of Plainfield or to I/O Solutions, Inc. for appropriate review and/or dissemination to those municipalities and/or Police Departments to which I have made application for employment or to which I will make application for employment. Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees may arise by reason of the disclosure of my medical records as authorized herein by me. Copyright 2011, I/O Solutions, Inc. PLAINFIELD PD REQUIRED DOCUMENT: 8 OF 11

PERSONAL INFORMATION TO MUNICIPALITY DISCLOSURE This is to inform you that in processing your application an investigation has been made whereby information is obtained concerning you. This information can include a record of all personal information, required by statute to be collected and maintained by government agencies. I understand that release of the results of the historical investigation profile will result in the disclosure of information regarding me to third parties. I hereby acknowledge the results of the investigation will be released to authorized representatives of the Village of Plainfield or to I/O Solutions, Inc., for appropriate review and dissemination to this municipality and/or Police Departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees may arise by reason of the investigation and the disclosure of any of that information. Copyright 2011, I/O Solutions, Inc. PLAINFIELD PD REQUIRED DOCUMENT: 9 OF 11

WRITTEN EXAMINATION By this written authorization I understand that release of the results of my Written Examination will result in disclosure of those test results to third parties. I hereby consent to the release of the results of my Written Examination for dissemination to the Village of Plainfield and to those municipalities and/or Police Departments (whichever is applicable) to which I have made application for employment or to which I will make application for employment. Police Commissioners, and I/O Solutions, Inc., its directors, officers, staff, employees, agents, representatives, and assignees may arise by reason of the Written Examination or due to the disclosure of the test and survey results as authorized herein by me. In the event that I have a disability which will affect my ability to take any examination, I will so inform the I/O Solutions, Inc. prior to the administration of the examinations so that a reasonable accommodation can be made. I/O Solutions, Inc. reserves the right to require medical documentation concerning the need for the accommodation. Copyright 2011, I/O Solutions, Inc. PLAINFIELD PD REQUIRED DOCUMENT: 10 OF 11

Village of Plainfield Employment Agreement Police Officer Employment Agreement I,, in advance of my appointment as a police officer with the Village of Plainfield, do hereby acknowledge that in the event I resign my position as a police officer within the first two (2) years, I will reimburse the Village of Plainfield all costs associated with training/uniforms, estimated to be $32,000, according to the following scale: Completed Quarters of Service % of Costs to be Repaid One 88% Two 75% Three 63% Four 50% Five 38% Six 25% Seven 13% Eight 0% Copyright 2011, I/O Solutions, Inc. PLAINFIELD PD REQUIRED DOCUMENT: 11 OF 11