BerryvillePoliceDepartment
101 Chalmers Ct., Suite A, Berryville, Virginia 22611
policeadmin@berryvilleva.gov
(540) 955-3863 (540) 955-0207 (Fax)
W. Neal White – Chief of Police
PD FORM 000 Page 1 of 7
REV 9/2018
Applicant Screening Questionnaire
The purpose of this questionnaire is to assist with the background investigation required to
determine if you meet the standards established by the Berryville Police Department. False or misleading
information will disqualify you from further consideration. Please do not leave any sections blank, if they
do not apply please indicate so. If you fail to complete any section, no further action will be taken on your
application. Thank you for your cooperation.
Date :
How
were
ou
referred?
Name:
Last
First
Middle
Address:
Telephone: (Home):
(Work):
Date of Birth:
Are
ou le
all
eli
ible to work in the U.S.?
Yes/ No
Do you have a valid driver’s license? Yes/ No
Issuin
State:
O.L.#:
EDUCATION
ame and location of Hi
h School attended:
Did
ou
raduate?
Yes/ No
If not, have
ou passed a GED test?
Yes/ No
Colle
e or Universit
:
School & Location From/To Degree Area of Study
Other Education:
School & Location From/To Degree Area of Study
Please list an
qualification and skills: