APPLICATION

First Name *

Middle Name:

Last Name *

SSN *

Age *

DOB: (mm-dd-yyyy) * +

State your SS# issued? *

Phone Number: *

Email Address *

Race *

Sex *

Physical Address *

City *

State *

Zip Code *

Are you able to work any shift and any day? *

Yes

No

Are you a U.S. Citizen? *

I was born in the U.S.

I am a Naturalized Citizen.

I am not a Citizen

If you are a Naturalized Citizen, please tell me where you were born?

How Did You Hear About Us? *

Please explain how you heard about us. *

What Position are you applying for? *

Are You a Lateral or Rehire? *

Name of Your Present or Past Department

Do you have 2 years of patrol experience?

Yes

No

Terminated From a Law Enforcement Agency? *

Yes

No

Reason for Termination?

Military Service? *

Type of Discharge?

Do you possess a Driver's License? *

Yes

No

Driver License Status? *

Were you arrested for a DUI, Hit and Run, or Reckless Driving? *

what year?

On Active Probation or Parole? *

Convicted of a Felony? *

Convicted of a Misdemeanor? *

Ever been arrested or given a copy of charges? *

Convicted of Obstruction, Eluding, Assaulting a Law Enforcement Officer? *

Have you ever taken a plea to avoid a conviction? *

Type of Arrest?

Named on a Restraining Order? *

Arrested for a Domestic Violence? *

what year?

Outside of Marijuana, have you used an illegal drug? *

Please provide the name of the drug or drugs used. *

I understand I will take an Oath of Office. *

Yes

I understand that this position requires an 8 to 10-hour work shift 24 hours a day. *

Yes

By signing below you agree that the information you have provided is true to the best of your knowledge. You understand that if you have provided false or misleading information this may disqualify you from our process. You understand that by signing, you will allow us to perform a criminal and credit check. If you have any documentation supporting your answers, please take the time to upload that documentation. *

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