Date of Age at Time of U.S.
Birth: Appointment:
Citizenship: Yes No
Place of Highest Grade Degree
Birth: Completed: Obtained:
Name and Location Date of
of High School: Graduation:
Date of GED or Testing
Equivalency: Center: City:
Military Date of Type of
Service: Yes No Discharge: Discharge:
(Please check Yes or No and complete if answer if Yes)
The applicant has not been convicted of or pleaded guilty to or entered a plea of nolo contendere to any felony charge or
to any violation of any federal or state laws or city ordinances relating to force, violence, theft, dishonesty, gambling,
liquor, or controlled substances. The applicant has not been released or discharged under any other than honorable
discharge from any of the armed forces of the United States.
Has the applicant ever been convicted of any criminal violation? Yes No
Has the applicant ever been convicted of anything other than a traffic violation? Yes No
Has the applicant ever been convicted of driving under the influence? Yes No
(If the answer to any of these questions is yes, attach a full explanation including date, location, charge(s), disposition,
court, and the law enforcement agency having jurisdiction. If yes, and the charges have been dismissed and expunged,
please attach a copy of the court document).
The Commission may consider a waiver from preemployment requirements (on an individual basis and depending on
circumstances) for an Entry Level Separation, a General Discharge under Honorable Conditions, or a misdemeanor
violation
Any person who, with intent to deceive, makes any false statement on this document commits the offense of
perjury pursuant to T.C.A. 39-16-702.
I certify that the information on this application is true and correct to the best of my knowledge.
Signature of Applicant Date
THE FOLLOWING DOCUMENTS MUST BE ON FILE AT THE EMPLOYING AGENCY AND READILY AVAILABLE
FOR INSPECTION BY ANY POST COMMISSION REPRESENTATIVE:
Copy of Application for Certification – Law Enforcement Officer (POST 1)
Copy of Confirmation of Psychological Evaluation (POST 1, Supplement A)
Copy of Confirmation of Medical Examination (POST 1, Supplement B)
Original Confidential Psychological Evaluation
Copy of Birth Certificate
Copy of High School Diploma/GED Certificate
Copies of all Military DD-214s, DD-215s, and DD-873s (if applicable)
POST 1 (Revised 10/02)
SF-1114 RDA 1494
