Employment Application – Mar-Mac Police Department

Application Instructions *

Acknowledge

The ability to follow direction and complete paperwork is an important responsibility of a police officers. 1. Your application should be hand printed legibly in ink, or typed; 2. Answer ALL questions completely. If a question does not apply to you, enter “N/A” in the space provided; 3. Avoid errors by reading the directions carefully before making entries on the form. Be sure your information is correct and in sequence before you begin; 4. YOU are responsible for obtaining COMPLETE and VALID addresses and zip codes, and valid telephone numbers where requested; 5. If there is insufficient space on the form, use the additional sheets provided at the end of this packet. Be sure to reference the relevant section and question on any supplemental pages or attachments; 6. If you have any questions concerning this packet, please contact Chief Millin at (563) 873-2500, or email rmillin@marmacpolice.org; 7. The attached “Authorization for Information and Examination Wavier” form must be completed and signed; 8. Copies of the following documents should be included with your application and forwarded to the Mar-Mac Police Department before the application due date (photocopies can be made at the Department’s office): a. Photocopy of current driver’s license; b. Photocopy of High School diploma, or GED certification; c. Photocopy of college transcript, diploma/certification, or degree; d. Photocopy of DD214 (military discharge form if applicable); e. Photocopy of Naturalization papers (if applicable). Failure to properly complete your application will result in the rejection of the application.

Date *

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Email Address *

Driver's License Number *

State *

HIGH SCHOOL EDUCATION

Name of High School *

Did you receive a high school diploma or a GED certificate? *

Diploma
Certificate
Other

Address of High School: *

Graduation Year *

POST HIGH SCHOOL EDUCATION

Starting with the most recent, list all colleges, universities, or trade schools you attended.

Did you attend any colleges, universities, or trade schools? *

Yes
No

Are you currently enrolled in colleges, universities, or trade schools? *

Yes
No

College, University, or Trade School:

Name of institution: If this question does not apply to you, enter “N/A." *

Did you receive a degree or a certificate of completion?

Degree
Certificate

Address of college, university, or trade school:

Number of Credit(s):

Course of Study:

Type of degree or name of certification:

ARMED FORCES

Have you ever been in the U.S. Armed Forces or National Guard? *

Yes
No

Have you ever served during time of conflict? *

Yes
No

Branch:

Rank:

If process? of

EMPLOYMENT HISTORY

Starting with the most recent, list all employers (paid and/or volunteer) you worked for in the last 10 years. If you were unemployed during any period within the last 5 years, list the date(s) you unemployed. Be sure to reference the relevant section and question on any supplemental pages or attachments.

Employer:

Start Date: *

End Date: *

Name of Employer: *

Employer's Phone Number *

Address of Employer: *

Name of Supervisor/Title: *

Position: *

Supervisor's Telphone Email:

Position and Duties: *

Reason for Leaving: *

RESIDENTIAL HISTORY

Starting with the most recent, list all locations where you have lived, regardless of period, for the last 10 years.

Residence:

From: *

To: *

Residential Address: *

Did you rent or owned your residence? *

Rent
Own
Other

Name of landlord (if applicable):

Landlord's Telephone Number:

FINANCIAL INFORMATION

LAW ENFORCEMENT CONTACTS

List all non-work related law enforcement contacts. Include the date of the offense, the issuing agency, the city and state of the offense, and the disposition of the offense. If this question does not apply to you, enter “N/A.”

Traffic Offenses:

List all traffic citations regardless of whether you were convicted. Include the date of the offense, the issuing agency, the city and state of the offense, and the disposition of the offense.

Traffic Citation(s):

Explain: *

Arrest(s) History:

List all arrest, including juvenile, regardless of whether you were convicted. Include the date of the offense, the issuing agency, the city and state of the offense, and the disposition of the offense.

Arrest(s):

Explain: *

CHARACTER REFERENCES

List five (5) character references that personally know you. Do not list employers, relatives, or supervisors. Do no list people that do not regularly interact with you.

Reference:

Name: *

Profession: *

Address: *

Years Known: *

Phone *

PERSONAL QUESTIONNAIRE

Answer the following questions truthfully. Each answer will be reviewed on a case-by-case basis and does not automatically disqualify you from the application process. Failing to answer a question, or not answering the question truthfully does automatically disqualify you from the application process. Some questions may require a written response. If a response is required, write your response. All answers are subject to verification.

Upload a copy of your resume. *