Fill - Free fillable Employment Application - Town Of Buena Vista Police Department PDF form

1

An Equal Opportunity Employer

We do not discriminate on the basis of race, color, religion, national origin, sex, age or disability. It

is our intention that all qualified applicants be given equal opportunity and that selection decisions

are based on job related factors.

All Police applicants must be Colorado POST certified.

General Instructions:

1. Print all information so that it is legible.

2. If an item does not apply to you, write N/A

3. A completed application is required

4. Any misstatements, misrepresentations or omissions by you, is cause for disqualification

from employment considerations.

5. All information is subject to verification.

Position in which you are applying

Name:

Last_____________________________ First______________________ Middle______________

Address________________________________City_________________ State______Zip_______

Home Phone________________ Cellular_________________ Business/Message_____________

Mailing Address (if different than above)_______________________________________________

Other name in which you have used, or have been known by (Please Explain)

Name: _________________________________________________________________________

Are you a citizen of the United States? _____

Are you at least 21 years of age? _____

Following the testing process, applicants who have scored the highest will be notified and will be

required to submit the following information.

1. Certified copy of birth certificate

2. Copy of Social Security Card

3. Copy of valid drivers’ license

4. Copy of High School Diploma or GED

5. Official College Transcripts (if applicable)

6. Military Discharge Form DD-214 (if applicable)

7. Copy of Colorado POST Law Enforcement Certificate (if applicable)

Buena Vista Police Department

713 East Main Street

P.O. Box 1310

Buena Vista CO 81211

719) 395-8654

719) 395-8655 fax

bvpd@buenavistaco.gov

2

Yes No General Information

Do you have any friends or relatives that are currently employed by the Buena

Vista Police Department?

Who / What relationship to you:________________________________________

Have you ever applied for any position with the Buena Vista Police Department?

Position(s) / Date(s) _________________________________________________

Have you ever been convicted of a crime? Provide details on a separate sheet.

Do you have a valid Colorado drivers’ license # ___________________________

Have you ever had your drivers’ license suspended or revoked?

Are you a certified Colorado Peace Officer? Certificate # ___________________

Are you able to perform the essential functions for the position in which you are

applying?

Are you willing to work shift work, including weekends, holidays and overtime?

Are you willing to submit to a credit history check?

Are you willing to consent to the following: Polygraph, Background investigation,

Drug test, Physical Examination and a Psychological Examination?

Have you ever bee a subject in a civil suit? Provide details on a separate sheet.

Are you presently an applicant or on an eligibility list for any other employer?

Please provide list.

Employer: __________________________ Position:_______________________

Have you ever been discharged from a job, or asked to resign?

If yes, please explain: _______________________________________________

______________________________________________________________________________

Have you ever received any disciplinary action from an employer?

If yes, please explain: _______________________________________________

______________________________________________________________________________

3

Yes No

Are you now, or have you ever been engaged in any business as an owner,

partner, or corporate member?

If yes, please explain: _______________________________________________

______________________________________________________________________________

Have you ever served in the Armed Forces? If yes, indicate what branch and type

of discharge._______________________________________________________

______________________________________________________________________________

How many days have you missed from work within the past year? (Exclude

absences due to disability or those covered by FMLA)______________________

What type of Police work are you interested in? (Patrol, Investigations, Juvenile, ect.)___________

______________________________________________________________________________

Have you ever used any illegal drugs; including, but not limited to Marijuana,

Hashish, Cocaine, LSD, Depressants, amphetamines, Tranquilizers, ect.?

If yes, what were the drug(s)?_________________________________________

______________________________________________________________________________

How many times?___________________________________________________

When was the last time?_____________________________________________

Do you associate with any person or persons who use illegal drugs?

If yes, please explain: _______________________________________________

______________________________________________________________________________

Have you ever been refused an auto insurance policy?

If yes, please explain: _______________________________________________

______________________________________________________________________________

4

Education

Circle highest grade completed GED 7 8 9 10 11 12 13 14 15 16 17 18

List all High schools attended (If GED, provide number, location and date)

High school attended: ______________________________________ From _______ to ________

Address:_______________________________________________________________________

High school attended: ______________________________________ From _______ to ________

Address:_______________________________________________________________________

List all College, University or institutes of higher learning attended.

Name: _________________________________________________ From_______to__________

Address________________________________________________________________________

Credit Hours____________________________________________________________________

Type of Degree__________________________________________________________________

Please describe any special qualifications and or skills:

______________________________________________________________________________

Volunteer Services:

List all Law Enforcement related volunteer / reserve services:

Name of agency__________________________________ Dates of service__________________

Position _________________________ Duties_________________________________________

Name of agency__________________________________ Dates of service__________________

Position _________________________ Duties_________________________________________

Name of agency__________________________________ Dates of service__________________

Position _________________________ Duties_________________________________________

5

Employment History

List name of employers in consecutive order with present or last employer first. Account for all

periods of time, including military service and any periods of unemployment. If you were self-

employed. Give the firm name and business references.

**Note: A job offer may be contingent upon acceptable references from current and former

employers.**

Present or last employer: Dates:from to

Address Weekly Hours Worked

Telephone # Name of supervisor:

Duties:

Co-Worker: (list one)

Reason for leaving:

Employer: Dates:from to

Address Weekly Hours Worked

Telephone # Name of supervisor:

Duties:

Co-Worker: (list one)

Reason for leaving:

Employer: Dates:from to

Address Weekly Hours Worked

Telephone # Name of supervisor:

Duties:

Co-Worker: (list one)

Reason for leaving:

Employer: Dates:from to

Address Weekly Hours Worked

Telephone # Name of supervisor:

Duties:

Co-Worker: (list one)

Reason for leaving:

6

Employer: Dates:from to

Address Weekly Hours Worked

Telephone # Name of supervisor:

Duties:

Co-Worker: (list one)

Reason for leaving:

Employer: Dates:from to

Address Weekly Hours Worked

Telephone # Name of supervisor:

Duties:

Co-Worker: (list one)

Reason for leaving:

Employer: Dates:from to

Address Weekly Hours Worked

Telephone # Name of supervisor:

Duties:

Co-Worker: (list one)

Reason for leaving:

Employer: Dates:from to

Address Weekly Hours Worked

Telephone # Name of supervisor:

Duties:

Co-Worker: (list one)

Reason for leaving:

Employer: Dates:from to

Address Weekly Hours Worked

Telephone # Name of supervisor:

Duties:

Co-Worker: (list one)

Reason for leaving:

7

References

List three people who know you well enough to provide current and past information about you. Do

not list relatives or former employers.

Name:_________________________________________________ Years Known:____________

Your relationship:________________________________________________________________

Address:_______________________________________________________________________

Telephone:____________________ Cellular:_________________ Business:_________________