Fillable EMPLOYMENT APPLICATION (City of Parkville)

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EMPLOYMENT APPLICATION (City of Parkville)

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BROWSE CITY OF PARKVILLE (MO) FORMS

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Parkville Police Department 8880 Clark Avenue Parkville, Missouri 64152 (816) 741-4454
Page 1
EMPLOYMENT APPLICATION
We consider applicants for all positions without regard to race, color,
religion, sex, national origin, age, marital or veteran status, the
presence of a non-job-related medical condition or handicap, or any
other legally protected status. We are an equal opportunity employer.
APPLICANT INFORMATION (PLEASE PRINT)
Position(s) Applied For
How Did You Learn About Us? Advertisement Friend/Relative Walk-In
Employment Agency Web Site Other
Last Name First M.I. Date
Street Address Apartment/Unit #
City State ZIP
Phone E-mail Address
Date Available Social Security No. Desired Salary
If you are under 18 years of age, can you provide required proof of your eligibility to work? YES NO
Have you ever filed an application with us before? YES Provide Date _________________________ NO
Have you been employed with us before? YES Provide Date _________________________ NO
Are you currently employed? YES NO May we contact your present employer? YES NO
Are you a citizen of the United States? YES NO If no, are you authorized to work in the U.S.? YES NO
Are you available to work Full Time Part Time Shift Work Temporary
Are you currently on ‘lay-off’ status and subject to recall? YES NO
Can you travel if a job requires it? YES NO
Have you been convicted of a felony within the last 7 years? YES NO
If yes, please explain:
EDUCATION
Elem
enta
ry
School
Address
From To Did you graduate? YES NO
Degree/Course
of Study
High School Address
From To Did you graduate? YES NO
Degree
of Study
College Address
Parkville Police Department 8880 Clark Avenue Parkville, Missouri 64152 (816) 741-4454
Page 2
From To Did you graduate? YES NO
Degree
of Study
Other Address
From To Did you graduate? YES NO
Degree/Course
of Study
Describe any specialized training, apprenticeship, skills and extra-curricular activities.
Describe any honors you received.
State any additional information you feel may be helpful to us in considering your application.
Indicate any foreign languages you can speak, read and or write
FLUENT
GOOD
FAIR
SPEAK
READ
WRITE
List professional, trade, business or civic activities and offices held in the space below.
You may exclude memberships which would reveal
sex, race, religion, national origin, age, ancestry, handicap or other protected status.
Parkville Police Department 8880 Clark Avenue Parkville, Missouri 64152 (816) 741-4454
Page 3
REFERENCES
Please provide name, address and telephone number of three references who are not related to you and are not previous employers.
Full Name Relationship
Company Phone ( )
Address
Full Name Relationship
Company Phone ( )
Address
Full Name Relationship
Company Phone ( )
Address
Are you physically or otherwise able to perform the duties of the job for which you are applying? YES No
PREVIOUS EMPLOYMENT
Start with your present or last job. Include any job related military service assignments and volunteer activities. You may exclude
organizations which indicate race, color, religion, gender, national origin, handicaps or other protected status.
Company Phone ( )
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
Company Phone ( )
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
Company Phone ( )
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
Parkville Police Department 8880 Clark Avenue Parkville, Missouri 64152 (816) 741-4454
Page 4
May we contact your previous supervisor for a reference? YES NO
If you need additional space, please continue on a separate sheet of paper.
MILITARY SERVICE
Branch From To
Rank at Discharge Type of Discharge
If other than honorable, explain
SPECIAL SKILLS AND QUALIFICATIONS
Summarize special job-related skills and qualifications acquired from employment or other experience in the space below.
DISCLAIMER AND SIGNATURE
I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment
decision.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be
considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization
is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time
with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or
by conduct unless such a change is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in
discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
Signature Date
Parkville Police Department 8880 Clark Avenue Parkville, Missouri 64152 (816) 741-4454
Page 5
PLEASE SUBMIT THIS APPLICATION WITH THE FOLLOWING:
• Birth Certificate or Naturalization Papers
• High School Diploma or GED Certificate
• If Former Military – DD 214
• If applying for position of Police Officer
Peace Officer Standards and Training Certificate or Number
Diploma from an approved Law Enforcement Academy
• Attached Authorization for Release of Personal Information (signature must be notarized)
FOR PERSONNEL DEPARTMENT USE ONLY
Arrange Interview YES No
Remarks ___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Employed YES
NO Date of Employment _______________________________________________
Job Title _________________________________ Hourly Rate/Salary ______________________ Department ______________
By (Name/Title) _____________________________________________________ Date ____________________________________
Parkville Police Department 8880 Clark Avenue Parkville, Missouri 64152 (816) 741-4454
Page 6
APPLICANT AUTHORIZATION AND AGREEMENT
In exchange for the City of Parkville’s consideration of my application for employment, I agree that any offer of
employment is conditional upon my submitting to drug and alcohol screening by the City. I also understand that
working under the influence of alcohol/drugs is prohibited by the City of Parkville. I understand that urine and
blood tests will be conducted and I hereby consent to those tests and any others required by the City in enforcing
its drug/alcohol policy. I authorize the release of the results of those tests to the City of Parkville and/or its
representatives. I hereby RELEASE the City of Parkville, the medical, clinical and testing laboratories and said
firms’ employees and representatives from any and all liability arising out of the administration of said tests and
the communication of the results.
__________________________________________
Applicant
__________________________________________
Date
__________________________________________
Witness
__________________________________________
Date
Parkville Police Department 8880 Clark Avenue Parkville, Missouri 64152 (816) 741-4454
Page 7
AUTHORIZATION FOR RELEASE OF PERSONAL INFORMATION
(SECURITY CHECK)
I ________________________________________ do hereby authorize a review and full disclosure of all
records concerning myself to any duly authorized officer of the City of Parkville, Missouri, and it’s Police
Department, whether the said records are of a public, private, or confidential nature.
The intent of this authorization is to give my consent for full and complete disclosure of the records of
educational institutions; financial or credit institutions, including records of loans, the records of commercial
or retail credit agencies (including credit reports and/or ratings) and other financial statements and records
wherever filed’ medical and psychiatric treatment and/or consultation including hospitals, clinics, private
practitioners, and the U.S. Veteran’s Administration; employment and pre-employment records, including
background reports, efficiency ratings, complaints or grievances filled by or against me; records and
recollections of attorneys at law, or of other counsel, whether representing me or another person in any
case, either criminal or civil, in which I presently have or have had an interest; and records involving any
incident where I have been convicted of a crime.
I understand that any information obtained by a personal history background investigation, which is
developed directly or indirectly, in whole or in part, upon this release authorization, may be considered in
determining my suitability for employment by the City of Parkville, Missouri. I understand that (1) the City
states that the use of such information will be in accordance with it’s employment policies and that such
information will not be used for any other purpose other than for consideration of the above as an employee
of the City, and (2) this background check is required because of the nature of the particular position that
I have made application in that it involves a sensitive position of person(s) who may furnish such information
concerning me shall not be held accountable for giving this information; and I do hereby release said
person(s) from any and all liability, which may be incurred as a result of furnishing such information.
A photocopy of this release form will be valid as an original thereof, even though the said photocopy does not
contain an original writing of my signature.
____________________________________ ________________________________________
Print Name Notary Public
____________________________________ ________________________________________
Maiden or other name by which you have been known Date
_________________________________________________________
Signature
_________________________________________________________
Address
____________________________________
Phone
____________________________________
DOB
____________________________________
Social Security
Parkville Police Department 8880 Clark Avenue Parkville, Missouri 64152 (816) 741-4454
Page 8
Qualified _______________________
Disqualified _______________________
PARKVILLE MISSOURI POLICE DEPARTMENT POLICE OFFICER
APPLICANT FORM
Print Name ________________________________________________ Date of Birth _________________
LAST FIRST M.I.
Address ___________________________________ City, State, Zip ________________________________
Social Security Number ______________________________ Telephone Number _____________________
SUBSTANCE ABUSE
Keep in mind that you will be taking a pre-employment polygraph. Any deviation from this form when compared to
the polygraph may result in disqualification.
Please complete the following drug usage form. Answer each category.
HAVE YOU EVER TRIED, USED, OR ARE YOU PRESENTLY USING:
YES NO DATE LAST USED
# OF
TIMES
1. Morphine
2. Cocaine (crack, rock, girl)
3. Heroin (boy, smack)
4. Methamphetamines (speed)
5. LSD (acid)
6. Marijuana (grass, weed, ganja)
7. PCP (angel dust, sharm, water)
8. Dilaudid
9. Hashish
10. Opium
11. Prescription Drugs not prescribed to you
12. Anabolic Steroids
13. Inhaled Solvents
14. Other Hallucinogens (mushrooms, mescaline)
15. Designer Drugs (MDMA, Ecstasy, etc.)
16. Others
Please initial verifying that you have read and understood this form _____________
Have you ever sold any illegal drugs? YES
NO
Aside from your current license, have you ever held a valid driver’s license in any other state? If yes, list below:
____________________________________________________________________________________
Parkville Police Department 8880 Clark Avenue Parkville, Missouri 64152 (816) 741-4454
Page 9
Referral Information
How did you hear that we were hiring? Please specify by checking each area that applies:
Newspaper Military University/College
Radio Friend/Relative Career Fair
Television Web Site Magazine
Parkville Police Department Member/Recruiter
Other _________________________________________________________________________
I hereby certify that there are no material misrepresentations or falsifications of the above answers to questions.
Should any part of your investigation disclose such material misrepresentations or falsification, I understand
that my application will be rejected and I will be disqualified from any position in the service of the Parkville
Missouri Police Department.
_________________________________________________________________
Signature
____________________________
Date
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EMPLOYMENT APPLICATION (City of Parkville)

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Completed 19 January 2021

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