Fill - Free fillable Police Officer Application KM 454e 20170203120221 (City of Ellsworth, Maine) PDF form

Integrity Professionalism Community Service

ELLSWORTH POLICE DEPARTMENT

1 CITY HALL PLAZA

ELLSWORTH, MAINE 04605

Tel. 207-667-2133 Fax 207-667-4916

Chief Glenn M. Moshier Captain Troy Bires

gmoshier@ellsworthmaine.gov tbires@ellsworthmaine.gov

POLICE OFFICER APPLICATION INFO

The Ellsworth Police Department is a proactive, professional department dedicated to the Core

Values of Integrity, Professionalism and Community Service. We pride ourselves on providing

high quality community focused police services. Duties for this position include the enforcement

of applicable state and local laws, criminal investigation, proactive crime prevention, patrol of the

city streets and traffic control. All candidates must have a high school diploma or equivalent with

preference given to candidates who are graduates of the Maine Criminal Justice Academy and

who possess law enforcement experience. The City of Ellsworth offers a competitive salary and

an exceptional benefit package. The salary is dependent on training and/or experience.

To ensure that the Ellsworth Police Department attracts the best qualified people and trains

those selected to the highest degree possible, the following policies are followed.

It is essential that individuals applying for employment be afforded the rights guaranteed by the

United States Constitution. The City of Ellsworth is an equal opportunity employer. All persons

applying for employment as a police officer shall meet the following requirements:

Shall be a U.S Citizen.

Shall possess a high school diploma or equivalency certificate.

Shall be at least 21 years of age.

Shall possess a valid driver’s license and shall not have an extensive accident history or

an extensive history of traffic violations.

Shall be required to fill out, take and successfully pass to the satisfaction of the Ellsworth

Police Department, any or all of the following: application, background information

form, physical agility test at the Maine Criminal Justice Academy minimum standard,

written exam, oral board questioning, background check, medical physical, polygraph

test, psychological test and chief’s interview. A copy of the fitness standards is included

with the application.

Shall be in excellent physical condition as determined by a physical examination

completed at the Police Department expense. The applicant must not be suffering from

any pre-existing disability, illness or injury, which, in the opinion of the examining

physician, would prevent the applicant from performing the duties of a police officer.

Integrity Professionalism Community Service

All applicants desiring employment with the Department:

Shall have successfully completed, at a minimum, the Maine Criminal Justice Academy

reserve officer training course. A copy of the MCJA Certificate of Eligibility for

employment as a law enforcement officer or the MCJA certificate of completion of the

Law Enforcement Pre-Service Training School must be included with the application.

Shall make written application on the form provided by the City of Ellsworth; a copy of the

ALERT test results must be included with the application

;

Shall submit copies of diplomas, certificates and training that relate to the qualifications

for the position.

Shall submit a signed Conditions of Consideration for Employment form.

Shall meet the mandatory physical fitness standards for full time officers. See attached

physical fitness standards.

The City of Ellsworth is an equal opportunity employer.

1

City of Ellsworth

1 City Hall Plaza

Ellsworth, ME 04605

Phone (207) 667-2563 ♦ Fax (207) 667-4908 ♦ www.ellsworthmaine.gov

Employment Application

We are an equal opportunity Employer

Date

Job Title/Position Opening you are applying for:

Last Name First Name

Address Phone

Address Email

All applicants who are offered employment must provide documentation to establish their identity and employment

eligibility for authorization to work in the U.S and must undergo a thorough background check.

Do you have the legal right to work in the U.S?

Date of Birth (if less than 18 years old):

Driver’s License No. & State: Class: Expiration Date:

Have you ever been employed by or done any volunteer work for the City of Ellsworth?

Do you have any relatives employed with the City of Ellsworth?

(If yes, please list name(s):

Please list all traffic convictions or accidents in the past 3 years:

Please list other names you have used in the past:

Have you ever been convicted of a crime? If yes, please give explanation.

2

Education

Did you receive a High School Diploma or GED equivalent?

Name of High School and location:

Name of School, College,

Or University

Major

Credit Hours

Degree*

*Proof of degrees from College/University will be required.

Name of Trade, Technical, Business,

Other School

Course of Study

Diploma

List other licenses held, date & license number; professional registrations & dates; certificates & professional

memberships:

List Honors, Awards, Fellowships:

Skills Overview

List computer software with which you are familiar:

List languages, other than English, that you speak fluently, read and/or write:

Summarize relevant skills & experience that exemplify your qualifications for the above position:

List tools & equipment you can operate:

Summarize Volunteer Services work you have done, including dates:

Summarize Leadership Roles you have experienced:

3

Employment History

Current or most recent employer:

Address: Phone:

Your Title: Dates of Employment – From: To:

Supervisor’s Name/Title:

Salary – Starting: Ending: Hrs. per Week:

Work/Tasks Performed:

Reason for Leaving:

Next most recent employer:

Address: Phone:

Your Title: Dates of Employment – From: To:

Supervisor’s Name/Title:

Salary – Starting: Ending: Hrs. per Week:

Work/Tasks Performed:

Reason for Leaving:

Next most recent employer:

Address: Phone:

Your Title: Dates of Employment – From: To:

Supervisor’s Name/Title:

Salary – Starting: Ending: Hrs. per Week:

Work/Tasks Performed:

Reason for Leaving:

4

City of Ellsworth

AUTHORIZATION FOR RELEASE OF INFORMATION

I, (print name) hereby authorize an employee of the City of

Ellsworth or other authorized representative bearing this release (or facsimile or copy) to, within one year of its

date, obtain information from past and/or current employers listed on the Employment Application as submitted

by me on (date) .

Employer’s Name:

Contact Person:

Employer’s Address:

I have filed an application for employment with the City of Ellsworth, Maine. Information regarding my

employment with your organization is as follows:

Dates of employment: From To

Position:

I hereby empower an employee of the City of Ellsworth or other authorized representatives bearing this release

(or facsimile or copy) to, within one year of its date, obtain information and records pertaining to me from any

or all of the following sources:

1. Municipal, State or Federal law enforcement agencies.

2. Selective Service System.

3. Any banking institution.

4. Any place of business (for purposes of obtaining credit or employment data).

5. Credit rating bureaus or institutions maintaining individual credit rating files.

6. Any previous employer.

7. Present employer.

8. Any school, college, university or other educational institution.

9. Other:

I hereby release any Municipal, State, or Federal law enforcement agency, individual or institution, including its

officers, employees, or 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.

Exceptions to this blanket authorization are:

NAME Address

SIGNATURE Date

Witness: Title:

Any information furnished relative to the application of the above individual will be treated with strictest confidence. An

applicant typically will not be eliminated or selected on the basis of a single reference. Please complete the employment

reference section attached.

5

City of Ellsworth, 1 City Hall Plaza, Ellsworth, ME 04605

BACKGROUND CHECK AUTHORIZATION

I, (print name) have filed an application for employment with the City of

Ellsworth, Maine for the position of ______________________________________ and understand that in

order to assess my qualifications a full background investigation is necessary. Certain positions may also be

conditioned on the successful completion of agility tests, skill evaluations, additional investigations and/or the

ability to be bonded. I therefore authorize the City of Ellsworth to conduct an investigation which may include

but not be limited to:

• Verification of all information provided by me to the City during the application process.

• Contacting employers (past and present), clients, business associates, professional organizations, or

other institutions, regarding work performance and character.

• Verification of licensure and/or educational attainment.

• Military Service Records.

• Complete Criminal Background Check. (Including State & Federal Law Enforcement Agencies)

• Credit check.

• Driver’s license check.

• Other:

I certify that all the information and materials I have provided to the City of Ellsworth as part of the

employment process are accurate and truthful. I realize that providing the City with false information or

intentionally withholding relevant information regarding my application may be grounds for rejection or

dismissal. If employed, I agree to provide proof of identity, relevant licensure or credentials, and authorization

for employment in the United States. Upon employment, I agree to abide by all municipal policies, regulations,

ordinances and established work safety practices.

I hereby agree to hold harmless and to release the City of Ellsworth, including its officers and employees or

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 to conduct a thorough background investigation.

PRINT NAME Current Address

Email Contact Information:

Telephone Contact Information:

Home Cell

Previous Addresses or Cities lived in within past 10 years

Social Security # Date of Birth Drivers License #

SIGNATURE Date

ELLSWORTH POLICE DEPARTMENT

1 City Hall Plaza P.O. Box 586 Ellsworth, ME 04605

Telephone - (207)667-2168 Fax – (207)667-4916

Internet – www.ellsworthmaine.gov E-Mail – gmoshier@ellsworthmaine.gov

CONDITIONS OF CONSIDERATION FOR EMPLOYMENT

All information contained on the application is subject to verification. The Ellsworth Police Department will conduct background

checks including, but not limited to, work references, driving records, criminal background records and education attainment.

I understand an employment offer is also contingent upon successful review of work references, and satisfactory result of a

background check. Certain positions are also conditioned on the successful completion of agility tests or skill evaluation and other

appropriate investigations.

I also understand that specific positions at the Ellsworth Police Department may require me to provide evidence of an acceptable

driving record.

I further understand that certain positions with the Department may require the applicant to be eligible for bonding. In such

instances, eligibility for bonding will be a consideration in determining an applicant’s fitness for such positions.

If employed, I agree to provide proof of identity, relevant licensure or credentials, and authorization for employment in the United

States.

If employed, I agree to abide by all municipal policies, regulations ordinances and established work safety practices.

When advised, reasonable accommodations will be made in order for an “Otherwise qualified applicant” with a disability to

participate in any phase of the application/recruitment process. (Americans with Disabilities Act of 1991)

I certify that all the information provided herein is true and complete to the best of my knowledge. I agree and understand that

omissions, misstatements, and falsifications will cause forfeiture on my part of all eligibility to any employment with the Ellsworth

Police Department and may be cause for rejection of this application, removal of my name from eligibility lists, or discharge from

municipal service.

In addition, I give the Ellsworth Police Department the right to investigate and verify any information obtained through the

application process. Permission is granted and I release from any and all liability any employer, agency or individual assisting the

Ellsworth Police Department in providing relevant job related information that will assist in this process.

It is my understanding that this application along with any resume and letters/notes of reference, other than those letters and notes

of reference I expressly submit in confidence, become a public document should I be hired by the Ellsworth Police Department.

As a result, I understand that the Ellsworth Police Department cannot guarantee me its confidentiality.

I have read and understand the above “Conditions of Consideration for Employment”

____________________________________________________________

(Printed Name)

_____________________________________________________________

(Signature)

_____________________________________________________________

Date

,.

POLICE

OFFICER

Nature

of

Work

This

is

responsible

field

work

in

carrying

out

general

duty

police

work

that

protects

the

lives

and

property

of

the

citizens

of

Ellsworth

through

the

enforcement

of

laws

and

ordinance.

Employee

of

this

class

is

responsible

for

performing

routine

police

assignments

which

are

received

from

police

officers

of

superior

rank

and

responding

to

calls

for

assistance

relayed

by

the

dispatcher.

Officer

may

receive

special

assignments

which

call

upon

specialized

abilities

and

knowledge.

Work

requires

the

use

of

discretion

and

judgment,

and

is

reviewed

through

direct

observation,

reports

and

discussions

by

superiors.

Examples

of

Work

(Illustrative

Only)

Patrols

the

City

in

a

radio

cruiser

or

on

foot.

Uses

radar

to

control

traffic

speeds

in

the

City

and

to

issue

citations

to

violators.

Answers

calls

and

complaints

involving

drunkenness,

domestic

disputes,

~obberies,

and

other

misdemeanors

and

felonies;

directs

traffic

at

scenes

of

accidents.

Prepares

reports

on

all

incidents

and

arrests.

Conducts

investigations,

gathers

evidence,

and

testifies

as

a

witness

in

court.

Interviews

persons

with

complaints

and

inquiries,

and

attempts

to

make

proper

disposition

or

direct

them

to

the

proper

authorities.

Conducts

accident

investigations,

interviews

principals

and

witnesses,

taking

statements;

examines

vehicles

and

roadways;

takes

necessary

street

measurements;

and

clears

the

street

of

obstruction

and

wreckage.

Participates

in

searching

and

booking

persons

arrested;

may

fingerprint

suspects

and

prisoners;

prepares

necessary

reports.

Responds

to

all

emergency

and

non-emergency

calls

from

the

public.

Performs

as

required.

Requirements

of

Work

Knowledge

of

the

principal

buildings,

streets,

and

physical

layout

of

City

and

adjoining

areas.

Knowledge

of

modern

principles

and

practices

of

pol

i

ce

work.

-

r

Police

Officer

(Continued)

Ability

to

cope

with

situations

firmly,

courteously,

tactfully,

and

with

respect

for

the

rights

of

others.

Ability

to

analyze

situations

quickly

and

objectively,

and

to

determine

proper

course

of

action,

ability

to

remember

names,

faces

and

details

of

incidents

often

under

stressful

conditions.

Ability

to

understand

and

carry

out

oral

and

written

instructions.

Ability

to

communicate

both

verbally

and

through

written

reports.

Ability

to

develop

skill

in

the

use

of

firearms,

and

the

operation

of

motor

vehicles.

Knowledge

of

first

aid

principles

and

skill

in

their

application.

Physical

strength

and

agility

sufficient

to

perform

the

work

of

the

class.

Desirable

Experience

and

Training

High

school

graduation,

preferably

supplemented

by a

two-year

degree

in

criminal

justice

studies;

or

any

equivalent

combination

of

training

and

experience.

Necessary

Special

Requirements

Must

possess

a

valid

motor

vehicle

operator's

license.

Must

be

a

graduate

of

Maine

Criminal

Justice

Academy,

within

12

months

of

date

of

hire.

Maine Criminal Justice Academy

Basic Law Enforcement Training Program

ENTRANCE PFT STANDARD (40

th

Percentile)

EXIT PFT STANDARD (50% Percentile)

The following three (3) test items constitute the physical fitness test (PFT)

REQUIREMENTS for the Basic Law Enforcement Training Program (BLETP).

Applicants must successfully complete each test at the 40

th

percentile entrance

standard (within one month from the start of the BLETP) and the 50

th

percentile

exit standard (prior to graduation of the BLETP) based on their age and gender.

1. One Minute Push-up test;

2. One Minute Sit-up test; and

3. 1.5 mile run

ιιιιιιιιιιιιιιιιιιιιιιιιιιιιιιιιιιιιιιιιιι

PHYSICAL FITNESS TEST DESCRIPTIONS:

ONE MINUTE PUSH-UP TEST: You will assume the standard position for a push-up, which is the

body rigid and straight from head to their heels (plank position) with the feet together and the hands

slightly wider than shoulder-width apart in the “UP” position. An administrator will place a 3-inch

measuring device on the surface directly under your chest, between and in line with the nipples of

your chest. With the back and remainder of the body straight at all times, you will lower the body

towards the floor until your sternum touches the 3-inch measuring device being held by the

administrator’s hand. You will then push to the fully extended UP position, so that the elbows come

to a near locked position. You can not wiggle to get to the UP position. This will complete one

repetition. You will complete as many correct push-ups as possible in 1 minute. You may rest only

in the UP position while maintaining your body in a straight position at all times during the test. If

you do not touch the 3-inch measuring device or do not go all the way up, those individual push-ups

do not count. If you come out of the plank position or any parts of your body touch the floor other

than your hands and feet, the test is over. The test administrator will count out loud only the number

of correct push-ups completed.

Scoring: The total number of correct push-ups in 1 minute.

ONE MINUTE SIT-UP TEST: The test will begin in the down position. You will lie down on your

back with knees bent and heels flat on the same level surface that you are lying down on. A partner

will hold your feet down. Your hands will be placed clasped behind your head. Fingers are

interlocked throughout the exercise. A correct sit-up is performed by sitting up until the upper body

is perpendicular to the floor. Usually this will mean that your elbows must touch the top of your

knees or extend beyond your lower legs. The complete sit-up is finished in the correct “UP”

position. You will return to a full lying position (with upper back touching the floor) before starting

the next sit-up. The buttocks must be kept in contact with the surface during the sit-up with no

thrusting of the hips. You will perform as many sit-ups as possible in 1 minute. If your buttocks

come off the floor, your fingers come unclasped, you do not come all the way up to perpendicular or

your shoulders do not touch the floor, those individual sit-ups will not count. The test administrator

will count out loud only the number of correct sit-ups completed.

Scoring: Your total number of correct sit-ups in 1 minute.

MCJA PHYSICAL FITNESS STANDARDS FOR LAW ENFORCEMENT 2

1.5 MILE RUN: The applicant will walk, jog, run, or any combination thereof, a distance of one and

one-half miles. A measured, level course will be used, such as an indoor or outdoor track. Exact

distances will be indicated. A monitor will keep record of the distance and time the applicant has

completed. If using a track, a monitor will inform the applicant at the end of each lap the cumulative

running time or a visual timing device will be observable by the applicant. The assigned monitor will

count out loud the number of laps completed.

Scoring: The time it takes to finish 1.5 miles.

Adopted by the MCJA Board of Trustees: 09/20/2013, effective 10/01/2013

FITNESS

MALE (40

th

Percentile)

AGE

FEMALE (40

th

Percentile)

AGE

TEST

20–29 30–39 40–49 50-59 20–29 30–39 40–49 50-59

One Minute Push-up Test

29 24 18 13 15 11 9 3

One Minute Sit-up Test

38 35 29 24 32 25 20 14

1.5 Mile Run

12.38

13:04

13:

49

15:03

14:50

15:

38

16:21

18:

07

Adopted by the MCJA Board of Trustees: 09/20/2013, effective 10/01/2013

FITNESS

MALE (50

th

Percentile)

AGE

FEMALE (50

th

Percentile)

AGE

TEST

20–29 30–39 40–49 50-59 20–29 30–39 40–49 50-59

One Minute Push -up Test

33 27 21 15 18 14 11 5

One Minute Sit-up Test

40 36 31 26 35 27 22 17

1.5 Mile Run

11.58

12:25

13:1

1

14:

16

14:07 14:34

15:

24

17:13

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Fill Online, Printable, Fillable, Blank Police Officer Application KM 454e 20170203120221 (City of Ellsworth, Maine) Form

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