Fill - Free fillable Mark R. Simlar PLEASE READ & FOLLOW DIRECTIONS (Charter Township of Waterford) PDF form

AN EQUAL OPPORTUNITY EMPLOYER

1

BOARD OF TRUSTEES

Gary Wall, Supervisor

Kim Markee, Clerk

StevenThomas, Treasurer

Anthony M. Bartolotta, Trustee

Marie E. Hauswirth, Trustee

Janet Matsura, Trustee

Mark Monohon, Trustee

5200 Civic Center Drive

Waterford, Michigan 48329-3773

Telephone: (248) 674-6252 Fax: (248) 618-7519

www.waterfordmi.gov

Mark R. Simlar

Human Resource Director

msimlar@waterfordmi.gov

PLEASE READ & FOLLOW DIRECTIONS CAREFULLY

January 5, 2021

Dear Police Applicant:

This Application and documentation of the following requirements must be returned to the Human Resource

Department by 4:00 p.m., on March 1, 2021. (We will not make copies)

Eligibility to apply for testing for Police Officer:

1. Certified or Certifiable Police Officer in the State of Michigan and documented proof of a passing score on the

M.C.O.L.E.S. Written and Physical agility tests. (or)

Currently enrolled in an accredited police academy. Must submit verification of enrollment with application.

Passing score on the M.C.O.L.E.S Written and Physical agility tests.

Proof of successful completion of the academy must be submitted within (14) fourteen days of graduation.

Without successful completion, applicant will be disqualified.

And one of the following:

A. A minimum of 60 credit hours of college from an accredited college or university (Official Transcripts)

B. Veteran with (4) four years of continuous active military service under honorable conditions within (5)

five years of application cut-off (or)

C. (2) two years employment as a certified full-time police officer in the State of Michigan as established

by M.C.O.L.E.S. within (2) two years of application cutoff.

If a sworn officer in another state, documented proof of your out of State certification taken through

M.C.O.L.E.S.

2. EMPCO, INC. written exam – passing score of 70 or better. Go to https://www.empco.net/testing/ for testing

information. Must be taken prior to application cut off.

Bonus Points: If you have military or police experience you may be eligible for Civil Service bonus points. If you wish to

receive bonus points you are required to provide documentation of any military or police experience at time of

application. Documentation for Police experience is a signed letter from your department on department letterhead

giving exact dates of full-time employment, Documentation for Military experience is your DD-214.

If you have questions about employment or the testing process, please call Human Resources at

(248) 674-6252.

AN EQUAL OPPORTUNITY EMPLOYER

2

5200 Civic Center Drive

Waterford, Michigan 48329-3773

Telephone: (248) 674-6252 Fax: (248) 618-7519

www.waterfordmi.gov

Full-time Police Officer

Applications are considered for employment without regard to race, color, religion, sex, national

origin, age, marital status and in compliance with State and Federal regulations on handicappers

civil rights. Under the Michigan Handicappers’ Civil Rights Act, a handicapper may allege a

violation of the Act regarding the failure to accommodate only if the handicapper notifies the

employer in writing of the need for accommodation within 182 days after the date the handicapper

knew or reasonable should have known that an accommodation was needed.

PLEASE PRINT IN BLACK INK OR TYPE

DATE: ____________________

NAME: ___________________________________________________________________________

Last First Middle

ADDRESS: ________________________________________________________________________

No. Street City State Zip

TELEPHONE: _________________________________ ___________________________________

(Area Code & Home Number) (Area Code & Work Number)

EMAIL ADDRESS: _________________________________________________________________

DATES OF ABOVE RESIDENCE: ____________________________________________________

From To

S.S. Number _______ - ______ - _______ DRIVER’S LICENSE NO: ______________________

PREVIOUS ADDRESS: _____________________________________________________________

No. Street City State Zip

U.S. CITIZEN? YES ____ NO ____ HIGH SCOOL GRADUATE? YES ____ NO ____

HAVE YOU EVER BEEN ARRESTED OR CONVICTED FOR A CRIME? YES ____ NO ____

ARE YOU NOW UNDER CHARGES FOR A CRIME? YES ____ NO ____

HAVE YOU EVER BEEN DISCHARGED OR FORCED TO RESIGN YES ____ NO ____

FROM A JOB?

AN EQUAL OPPORTUNITY EMPLOYER

3

LIST ALL TRAFFIC OFFENSES FOR THE LAST THREE YEARS (INCLUDE DATES):

HAVE YOU EVER HAD YOUR DRIVER’S LICENSE SUSPENDED OR REVOKED? YES ____ NO ____

HAVE YOU EVER BEEN REQUIRED TO ATTEND DRIVER SAFETY SCHOOL? YES ____ NO ____

HAVE YOU EVER BEEN INVOLVED IN AN ACCIDENT IN WHICH YOU RECEIVED

A TRAFFIC CITATION? YES ____ NO ____

HAVE YOU EVER BEEN IN MILITARY SERVICE? YES ____ NO ____

DATE ENTERED: _______________________ DATE OF DISCHARGE: ________________________

TYPE OF DISCHARGE: __________________ RANK UPON DISCHARGE: _____________________

BRANCH OF SERVICE: __________________

JOB CLASSIFICATION IN SERVICE & TRAINING: _____________________________________________

EDUCATIONAL BACKGROUND

CIRCLE HIGHEST GRADE COMPLETED

HIGH SCHOOL 9 10 11 12 COLLEGE 1 2 3 4 5

HIGH SCHOOL GED? YES _____ NO _____

SCHOOL

NAME & ADDRESS

DATES MAJOR GRADE AVR.

DEGREE

G GRADE

SCHOOL

H HIGH

SCHOOL

COLLEGE

GRADUATE

SCHOOL

BUSINESS

SCHOOL

MILITARY

We do not accept faxed copies of applications or documents

AN EQUAL OPPORTUNITY EMPLOYER

4

EMPLOYMENT HISTORY

LIST BELOW YOUR EMPLOYMENT HISTORY STARTING WITH YOUR PRESENT OR MOST RECENT

JOB FIRST. If ADDITIONAL SPACE IS REQUIRED, LIST ON A SEPARATE SHEET AND ATTACH TO

APPLICATION. PLEASE COMPLETE IN DETAIL.

1. EMPLOYER: _______________________________________________________________________________

ADDRESS: _____________________________________________________________________________

No. Street City State Zip

TELEPHONE NUMBER: _________________________ YOUR JOB TITLE:_______________________

DATE STARTED: ______________________________ DATE TERMINATED: ___________________

WAGES: $ ___________________ PER: ____________ SUPERVISOR’S NAME: __________________

REASON FOR LEAVING: ________________________________________________________________

2. EMPLOYER: _______________________________________________________________________________

ADDRESS: _____________________________________________________________________________

No. Street City State Zip

TELEPHONE NUMBER: _________________________ YOUR JOB TITLE:_______________________

DATE STARTED: ______________________________ DATE TERMINATED: ___________________

WAGES: $ ___________________ PER: ____________ SUPERVISOR’S NAME: __________________

REASON FOR LEAVING: ________________________________________________________________

3. EMPLOYER: _______________________________________________________________________________

ADDRESS: _____________________________________________________________________________

No. Street City State Zip

TELEPHONE NUMBER: _________________________ YOUR JOB TITLE:_______________________

DATE STARTED: ______________________________ DATE TERMINATED: ___________________

WAGES: $ ___________________ PER: ____________ SUPERVISOR’S NAME: __________________

REASON FOR LEAVING: ________________________________________________________________

4. EMPLOYER: _______________________________________________________________________________

ADDRESS: _____________________________________________________________________________

No. Street City State Zip

TELEPHONE NUMBER: _________________________ YOUR JOB TITLE:_______________________

DATE STARTED: ______________________________ DATE TERMINATED: ___________________

WAGES: $ ___________________ PER: ____________ SUPERVISOR’S NAME: __________________

REASON FOR LEAVING: ________________________________________________________________

AN EQUAL OPPORTUNITY EMPLOYER

5

MAY WE CONTACT PRESENT AND/OR ALL PREVIOUS EMPLOYERS? YES _____ NO _____

LIST EXCEPTIONS AND REASONS: _______________________________________________________

LIST HOBBIES, LEISURE TIME ACTIVITIES AND INTERESTS: _______________________________

________________________________________________________________________________________

LIST ALL CLUBS, FRATERNITIES, BUSINESS, PROFESSIONAL CIVIC OR OTHER ORGANIZATIONS TO

WHICH YOU BELONG: (EXCLUDE THOSE WHICH INDICATE RACE, CREED, COLOR OR NATIONAL

ORIGIN):

________________________________________________________________________________________

CHARACTER REFERENCES (EXCLUDE RELATIVES AND FORMER EMPLOYERS)

1. _____________________________________ _____________________________________

Name Address

________________________________________ _________________________________________

Telephone Number Occupation

2. _____________________________________ _____________________________________

Name Address

________________________________________ _________________________________________

Telephone Number Occupation

3. _____________________________________ _____________________________________

Name Address

________________________________________ _________________________________________

Telephone Number Occupation

CREDIT REFERENCES – (Ex: Mortgage Company, Financial Institution, Credit Card, Car loans etc.)

Name Address Telephone Number

1.________________________________________________________________________________________________________

2.________________________________________________________________________________________________________

3.________________________________________________________________________________________________________

We do not accept faxed copies of applications or documents

AN EQUAL OPPORTUNITY EMPLOYER

6

WHY ARE YOU INTERESTED IN EMPLOYMENT WITH THE WATERFORD TOWNSHIP POLICE

OR FIRE DEPARTMENT?

_____________________________________________________________________________________

.

We do not accept faxed copies of applications or documents

AN EQUAL OPPORTUNITY EMPLOYER

7

AGREEMENT AND UNDERSTANDING

THE INFORMATION FURNISHED ON THIS APPLCATION AND SUPPLEMENTS THEREOF IS

COMPLETE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. I AUTHORIZE

WATERFORD TOWNSHIP TO VERIFY OR INVESTIGATE THIS INFORMATION AND ALSO

AUTHORIZE THE ORGANIZATIONS AND PERSONS NAMED IN THE APPLICATION TO

RELEASE INFORMATION REGARDING ME. I UNDERSTAND THAT MY FURNINSHING OF

ANY FALSE INFORMATION ON THIS OR ANY TOWNSHIP RECORD IS REASON FOR

DISQUALIFICATION AS A CANDIDATE FOR EMPLOYMENT OR CAUSE FOR TERMINATION

IF I AM EMPLOYED. I AGREE TO HOLD THE CHIEF OF POLICE, FIRE CHIEF, THE

TOWNSHIP BOARD, TOWNSHIP OFFICIALS AND THE CIVIL SERVICE COMMISSION AND

THEIR EMPLOYEES OR AGENTS HARMLESS FROM ANY AND ALL DAMAGE THEY MIGHT

SUFFER BY REASON OF ANY ACT OR COMMISSION OF MINE.

____Placing a check in the box serves two purposes: (1) that the person filing this form is the

actual applicant (2) The person understands and agrees to this provision.

UNDER THE PROVISIONS OF THE OPEN MEETING ACT, PUBLIC ACT NO. 267 OF 1976,

PASSED BY THE STATE OF MICHIGAN AND EFFECTIVE APRIL 1, 1977, I UNDERSTAND

THE REVIEW OF MY APPLICATION FOR EMPLOYMENT BY THE WATERFORD TOWNSHIP

CIVIL SERVICE COMMISSION IS SUBJECT TO AN OPEN PUBLIC MEETING.

I HEREBY REQUEST A WAIVER, SO THAT MY APPLICATION FOR EMPLOYMENT IS NOT

REVIEWED AT A PUBLIC MEETING, BUT INSTEAD THAT MY APPLICATION REMAIN

CONFIDENTIAL UNDER THE PROVISIONS OF THIS ACT. BY SIGNING BELOW, THIS

MEANS I WISH TO HAVE MY APPLICATION REVIEWED IN A CLOSED MEETING.

____My application can be reviewed in an open meeting ____I do not want an open meeting

I AUTHORIZE THE CHARTER TOWNSHIP OF WATERFORD TO RELEASE ANY

INFORMATION (EVEN IF MORE THAN FOUR YEARS OLD) RELATING IN ANY WAY TO MY

EMPLOYMENT INCLUDING DISCIPLINARY REPORTS, LETTERS OF REPRIMAND OR

OTHER NOTICES OF DISCIPLINARY ACTION WHEN SUCH INFORMATION IS REQUESTED

BY ANY PROSPECTIVE OR SUBSEQUENT EMPLOYERS WITHOUT ANY OBLIGATION (BY

THEM OR YOU) TO GIVE ANY NOTICE OF SUCH DISCLOSURE.

____Placing a check in the box serves two purposes: (1) that the person filing this form is the

actual applicant (2) The person understands and agrees to this provision.

We do not accept faxed copies of applications or documents

AN EQUAL OPPORTUNITY EMPLOYER

8

AGREEMENT AND UNDERSTANDING

(CONTINUED)

I UNDERSTAND THAT ANY EMPLOYMENT OFFER IS CONDITIONAL UPON THE RESULT

OF A DRUG SCREENING TEST, A POST OFFER PRE-EMPLOYMENT MEDICAL

EXAMINATION AND PSYCHOLOGICAL EVALUATION.

____Placing a check in the box serves two purposes: (1) that the person filing this form is the

actual applicant (2) The person understands and agrees to this provision.

IF EMPLOYED, I UNDERSTAND THAT IF I AM OR BECOME HANDICAPPED IN NEED OF

ACCOMMODATIONS FOR EMPLOYMENT, I MUST NOTIFY THE OFFICE OF FISCAL &

HUMAN RESOURCES IN WRITING WITHIN 182 DAYS AFTER THE NEED IS KNOWN OR

REASONABLY SHOULD HAVE BEEN KNOWN TO ME. FAILURE TO PROPERLY NOTIFY

THE TOWNSHIP WILL PRECLUDE ANY CLAIM THAT THE EMPLOYER FAILED TO

ACCOMMODATE THE HANDICAPPER.

____ Placing a check in the box serves two purposes: (1) that the person filing this form is the actual

applicant (2) The person understands and agrees to this provision.

I UNDERSTAND THAT, AS A CONDITION OF MY CONSIDERATION FOR EMPLOYMENT

WITH THE CHARTER TOWNSHIP OF WATERFORD (“TOWNSHIP”) AND AS A CONDITION

OF MY CONSIDERATION FOR EMPLOYMENT WITH THE TOWNSHIP, THE TOWNSHIP MAY

OBTAIN A CONSUMER REPORT THAT INDICATES, BUT IS NOT LIMITED TO, MY

CREDITWORTHINESS OR SIMILAR CHARACTERISTICS, EMPLOYMENT AND EDUCATION

VERIFICATION, SOCIAL SECURITY VERIFICATION, CRIMINAL AND CIVIL HISTORY,

PERSONAL INTERVIEWS, DRIVING RECORDS, ANY OTHER PUBLIC RECORDS AND ANY

OTHER INFORMATION BEARING ON MY CREDIT STANDING, CREDIT CAPACITY,

CHARACTER, GENERAL REPUTATION, PERSONAL CHARACTERISTICS AND

TRUSTWORTHINESS.

I HEREBY AUTHORIZE AND CONSENT TO THE TOWNSHIP’S PROCUREMENT OF SUCH A

REPORT. I UNDERSTAND THAT, PURSUANT TO THE FEDERAL FAIR CREDIT REPORTING

ACT, THE TOWNSHIP WILL PROVIDE ME WITH A COPY OF ANY SUCH REPORT IF THE

INFORMATION IN SUCH REPORT IS, IN ANY WAY, TO BE USED IN MAKING A DECISION

REGARDING MY FITNESS FOR EMPLOYMENT WITH THE TOWNSHIP. I FURTHER

UNDERSTAND THAT SUCH REPORT WILL BE MADE AVAILABLE TO ME PRIOR TO ANY

SUCH DECISION BEING MADE, ALONG WITH THE NAME AND ADDRESS OF THE

REPORTING AGENCY THAT PRODUCED THE REPORT.

____Placing a check in the box serves two purposes: (1) that the person filing this form is the

actual applicant (2) The person understands and agrees to this provision.

We do not accept faxed copies of applications or documents

AN EQUAL OPPORTUNITY EMPLOYER

9

AGREEMENT AND UNDERSTANDING

(CONTINUED)

I AGREE THAT ANY LAWSUIT AGAINST THE TOWNSHIP ARISING OUT OY MY

EMPLOYMENT OR TERMINATION OF EMPLOYMENT, INCLUDING BUT NOT

LIMITED TO, CLAIMS ARISING UNDER THE STATE OR FEDERAL CIVIL RIGHTS

STATUTES, MUST BE FILED WITHIN ONE YEAR OF THE EVENT GIVING RISE TO

THE CLAIMS OR BE FOREVER BARRED. I WAIVE ANY LIMITATIONS PERIOD TO

THE CONTRARY.

____Placing a check in the box serves two purposes: (1) that the person filing this form is the

actual applicant (2) The person understands and agrees to this provision.

IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE RULES

AND REGULATIONS OF THE CHARTER TOWNSHIP OF WATERFORD. I FURTHER

ACKNOWLEDGE I WILL BE ON PROBATIONARY STATUS FROM MY DATE OF

HIRE. AS A PROBATIONARY EMPLOYEE, I AM REQUIRED TO WORK DURING THE

PROBATIONARY PERIOD WITHOUT INTERRUPTIONS. AS A PROBATIONARY

EMPLOYEE, I UNDERSTAND MY EMPLOYMENT AND COMPENSATION CAN BE

TERMINATED AT ANY TIME WITHOUT CAUSE AND WITH OR WITHOUT NOTICE

AT THE OPTION OF THE TOWNSHIP OR MYSELF. I UNDERSTAND THAT NO

OFFICER OR REPRESENTATIVE OF THE TOWNSHIP HAS THE AUTHORITY TO

ENTER INTO AN AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF

TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING, EXCEPT

THE TOWNSHIP SUPERVISOR, AND ANY SUCH AGREEMENT MUST BE MADE IN

WRITING, DIRECTED TO ME PERSONALLY. I FURTHER ACKNOWLEDGE THAT

AFTER MY PROBATIONARY PERIOD ENDS, I WILL BE SUBJECT TO THE TERMS

AND CONDITIONS OF A COLLECTIVE BARGAINING AGREEMENT.

____Placing a check in the box serves two purposes: (1) that the person filing this form is the

actual applicant (2) The person understands and agrees to this provision.

We do not accept faxed copies of applications or documents

AN EQUAL OPPORTUNITY EMPLOYER

10

RELEASE OF INFORMATION

TO WHOM IT MAY CONCERN

I hereby authorize any representative of the Charter Township of Waterford bearing this release

to obtain information from your files or other sources pertaining to my personal background

including, but not limited to, academic, athletic, achievement, attendance, personal history,

disciplinary action, medical, credit or any other records you may have regarding me. I hereby

direct you to release such information upon the request of the bearer. This release is executed

with the full knowledge and understanding that the information is for the official use of the

Charter Township of Waterford. Consent is granted for the Charter Township of Waterford to

furnish such information as is described above, to third parties in the course of the Charter

Township of Waterford fulfilling its official responsibilities with regard to my application for

employment. I hereby release you, the institution or establishment which you represent

including its officers, employees, and related personnel, both individually and collectively, from

any and all liability for damages of whatever kind, which may at any time result to me, my

heirs, family or associates because of compliance with this authorization and request to release

information, or any attempt to comply with it. Should there be any question as to the validity of

this release, you may contact me as indicated below:

FULL NAME (PRINT OR TYPE) _____________________________________________

_____________________________________ _____________________________

DATE OF BIRTH TELEPHONE NUMBER

_____________________________________ ______________________________

DRIVER’S LICENSE NUMBER SOCIAL SECURITY NUMBER

______________________________________________________________________________

CURRENT ADDRESS: NUMBER & STREET NAME CITY STATE ZIP

____Placing a check in the box serves two purposes: (1) that the person filing this form is the

actual applicant (2) The person understands and agrees to this provision.

DATE

Authority: Act 78 of P.A. of 1935 Completion Voluntary

Act 155 of P.A. of 1986

We do not accept faxed copies of applications or documents

You can save and email your application with attachments to

award@waterfordmi.gov

ALL DOCUMENTS MUST BE SUBMITTED WITH YOUR APPLICATION

Fill Online, Printable, Fillable, Blank Mark R. Simlar PLEASE READ & FOLLOW DIRECTIONS (Charter Township of Waterford) Form

Related forms

Fillable Mark R. Simlar PLEASE READ & FOLLOW DIRECTIONS (Charter Township of Waterford)

Fill Online, Printable, Fillable, Blank Mark R. Simlar PLEASE READ & FOLLOW DIRECTIONS (Charter Township of Waterford) Form

Related forms

First 20 documents completely FREE!