Police Clerk Application

Position Requested

Job Position

Contact Information

First Name

Middle Name

Last Name

Phone Number

Email Address

Other Name

List any other name you have ever been known by

First Name

Middle Name

Last Name

Address

Address Line 2

City

State

Zip

Are any of your relatives employed by the City of Loves Park

Yes

High School

Have you earned a high school diploma or G.E.D. certificate?

Yes

School Name

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

List years attended

Graduated?

Yes

College / University #1

School Name

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

List years attended

Graduated?

Yes

College / University #2

School Name

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

List years attended

Graduated?

Yes

College / University #3

School Name

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

List years attended

Graduated?

Yes

College / University #4

School Name

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

List years attended

Graduated?

Yes

College / University #5

School Name

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

List years attended

Graduated?

Yes

Other Education (If Applicable/Please Specify)

School Name

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

List years attended

Graduated?

Yes

Type of Education

Specialized Training and Skills

Certification

Licenses

Skills

Employment History #1

Name of Employer

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

Job Title

Start Date

End date

Hours per week

Job Duties

Reasons for leaving

Supervisor's Name

Supervisor's Email

Supervisor's Phone

Do you object to our contacting them?

Yes

Employment History #2

Name of Employer

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

Job Title

Start Date

End date

Hours per week

Job Duties

Reasons for leaving

Supervisor's Name

Supervisor's Email

Supervisor's Phone

Do you object to our contacting them?

Yes

Employment History #3

Name of Employer

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

Job Title

Start Date

End date

Hours per week

Job Duties

Reasons for leaving

Supervisor's Name

Supervisor's Email

Supervisor's Phone

Do you object to our contacting them?

Yes

Employment History #4

Name of Employer

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

Job Title

Start Date

End date

Hours per week

Job Duties

Reasons for leaving

Supervisor's Name

Supervisor's Email

Supervisor's Phone

Do you object to our contacting them?

Yes

Employment History #5

Name of Employer

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

Job Title

Start Date

End date

Hours per week

Job Duties

Reasons for leaving

Supervisor's Name

Supervisor's Email

Supervisor's Phone

Do you object to our contacting them?

Yes

Employment History #6

Name of Employer

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

Job Title

Start Date

End date

Hours per week

Job Duties

Reasons for leaving

Supervisor's Name

Supervisor's Email

Supervisor's Phone

Do you object to our contacting them?

Yes

Employment History #7

Name of Employer

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

Job Title

Start Date

End date

Hours per week

Job Duties

Reasons for leaving

Supervisor's Name

Supervisor's Email

Supervisor's Phone

Do you object to our contacting them?

Yes

Employment History #8

Name of Employer

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

Job Title

Start Date

End date

Hours per week

Job Duties

Reasons for leaving

Supervisor's Name

Supervisor's Email

Supervisor's Phone

Do you object to our contacting them?

Yes

Additional Open Ended Questions

Have you ever served in the military?

Yes

Are you now, or were you ever a member of the U.S Reserve Forces or National Guard?

Yes

Have you ever been terminated from a job?

Yes

Have you ever applied to the Loves Park Police Department?

Yes

Have you ever taken a Civil Service Exam (police or fire)?

Yes

Are you currently on any police or fire eligibility lists?

Yes

As a driver, have you ever been involved in a traffic accident?

Yes

Have you ever been charged or convicted of a criminal offense?

Yes

Have you ever been placed on probation for a criminal offense?

Yes

Have you ever received a traffic citation?

Yes

Have you ever been sued?

Yes

Have you ever been convicted of a felony?

Yes

Employment Gaps

Please explain any employment gaps

Additional Employment Experiences

List any other employment experiences that you have, which you believe are related to the job of police officer.

Eligibility Questions

Are you 21 years of age and under 35 of age at the time of this application?

Yes

Personal Reference #1

Name

Relationship

No. of Years Acquainted

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

Phone

Personal Reference #2

Name

Relationship

No. of Years Acquainted

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

Phone

Personal Reference #3

Name

Relationship

No. of Years Acquainted

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

Phone

Residence History #1

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

From Date

To Date

Residence History #2

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

From Date

To Date

Residence History #3

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

From Date

To Date

Residence History #4

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

From Date

To Date

Residence History #5

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

From Date

To Date

Proof of citizenship form (proof of authorization to work in the US)

Are you a naturalized U.S. citizen?

Yes

Voluntary Equal Employment Opportunity Form

Completion of this form is completely voluntary and will have absolutely no impact on your application. The information requested on this form is being collected to ensure fairness of the selection procedures and will be processed separately from the remainder of the your application. Your participation, n completing this voluntary form would be greatly appreciated.

What is your date of birth?

What is your gender?

How would you identify yourself?

How did you hear about this job opportunity?

CERTIFICATION OF HONESTY

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed my application. I understand that my omission or misstatement of material fact on this application or on any document used to secure employment shall result in my withdrawal from consideration for employment, or immediate termination from employment.

I Agree

I agree to electronically sign this document and assert that I have read, understand, and agree to the terms and conditions.

I Agree

You may request a reasonable accommodation to facilitate the application process, including a reasonable accommodation to enable you to participate in the interview process. Applications requesting a reasonable accommodation will be given the same considerations as other applicants.

This application is a questionnaire regarding possible employment. It is not an offer of employment. Loves Park, in its sole discretion, will make a later decision as to whether or not it will make an offer of employment to you. If there is a later decision by Loves Park to hire you, Loves Park will notify you and any later employment is "at will" which means that employment can be terminated at any time with or without cause, reasons or notice.

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