3
Do you have physical or mental condition or moral conviction, which would prevent _____ Yes _____ No
you from stopping & physically searching persons?
Do you have physical or mental condition or moral conviction, which would prevent _____ Yes _____ No
you from operating a motor vehicle?
Do you have physical or mental condition or moral conviction, which would prevent _____ Yes _____ No
you from physically touching, examining or searching a dead body?
Do you have physical or mental condition or moral conviction, which would prevent _____ Yes _____ No
you from using physical force to restrain a person?
Do you have physical or mental condition or moral conviction, which would prevent _____ Yes _____ No
you from using weapons to assist in restraining a person?
Do you have physical or mental condition or moral conviction, which would prevent _____ Yes _____ No
you from catching a falling person?
Do you have physical or mental condition or moral conviction, which would prevent _____ Yes _____ No
you from discharging a firearm at a person or animal in a deadly force situation?
Do you have physical or mental condition or moral conviction, which would prevent _____ Yes _____ No
you from securing a firearm in your personal residence?
Do you have physical or mental condition or moral conviction, which would prevent _____ Yes _____ No
you from performing first aid to a bleeding or severely injured person?
Do you have physical or mental condition or moral conviction, which would prevent _____ Yes _____ No
you from talking to a person attempting suicide?
Do you have physical or mental condition or moral conviction, which would prevent _____ Yes _____ No
you from placing children in protective custody?
Do you have physical or mental condition or moral conviction, which would prevent _____ Yes _____ No
you from conducting investigations of any and all crimes?
Do you have a certificate of training in the use of firearms? _____ Yes _____ No
Are you a member of any organization which advocates overthrowing the United States _____ Yes _____ No
Government by violence means?
Personal References other than previous employers and relatives:
Name Address Phone
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Applicants Acknowledgement
I certify answers given in this application are true and correct to the best of my knowledge. I authorize all
necessary investigation into all statements I have made on this application in reaching an employment decision.
As a condition of my employment, I accept the principle that the welfare of the organization depends upon the
conduct and honesty of its’ employees and the trust and confidence of our customers and the public in general. The
organization expects honesty, security, and confidentiality. I therefore agree to the following:
In the event I am employed, I understand that any false or misleading information I knowingly provided in my
application or interview(s) may result in discharge and/or legal action. I understand also that if employed, I am
required to abide by all the rules and regulations of the employer and any special agreements reached by the
employer and me.
____________________________________________________ _______________________________
Signature of Applicant Date
Application Form adopted by the Civil Service Commission on the 17
th
Day of May 2007, revised on the 12
th
day of
April, 2010; Mack Dennis, president.
