PAWTUCKET POLICE DEPARTMENT APPLICATION FOR EMPLOYMENT

Transcription

1 PAWTUCKET POLICE DEPARTMENT APPLICATION FOR EMPLOYMENT PERSONAL INFORMATION: 1. NAME (please print): Last First Middle Maiden 2. PRESENT ADDRESS: Street City State Zip Years There 3. PREVIOUS ADDRESS: Street City State Zip Years There 4. * ADDRESS *PLEASE BE SURE THE ADDRESS PROVIDED IS A VALID ADDRESS, AS ALL CORRESPONDENCE AFTER THE RETURN OF YOUR APPLICATION WILL BE FORWARDED TO THAT ADDRESS. 5. TELEPHONE #: ( ) Cell ( ) Home 6. FATHER S FULL NAME: ADDRESS: 7. MOTHER S MAIDEN NAME: ADDRESS: 8. HAVE YOU EVER HAD A RESTRAINING ORDER, OR A TEMPORARY RESTRAINING ORDER FILED AGAINST YOU IN THIS OR ANY OTHER STATE? IF YES, PLEASE EXPLAIN ON A SEPARATE SHEET OF PAPER. 9. DID YOU SERVE IN THE MILITARY? If YES, Which BRANCH of SERVICE: Entry Date: Discharge Date: Discharge Type: Rank: Please provide a copy of your DD DO YOU HAVE ANY PHYSICAL LIMITATIONS THAT PRECLUDE YOU FROM PERFORMING ANY WORK FOR WHICH YOU ARE BEING CONSIDERED? YES NO If YES, give details on a separate sheet of paper. 11. ARE YOU A CITIZEN OF THE UNITED STATES? IF NATURALIZED, LIST DATE & COURT: 12. DRIVERS LICENSE # HAVE YOU EVER HELD A DRIVERS LICENSE IN ANOTHER STATE?

2 IF SO, WHICH STATE: DO YOU HAVE A MOTORCYCLE LICENSE? EDUCATION: 13. HIGH SCHOOL, COLLEGE, BUSINESS SCHOOL, TRADE SCHOOL AND OTHER EDUCATION NAME OF SCHOOL YEARS COMPLETED DATES ATTENDED MAJOR SUBJECT DEGREE OR CERTIFICATE EMPLOYMENT: 14. BEGIN WITH YOUR PRESENT OR MOST RECENT EMPLOYMENT. NAME, ADDRESS, TELEPHONE # OF EMPLOYER & SUPERVISOR POSITION DATES OF EMPLOYMENT (FROM TO) REASON FOR LEAVING

3 CRIMINAL BACKGROUND: 15. HAVE YOU, IN THIS STATE OR ELSEWHERE, BEEN SENTENCED, GIVEN A DEFERRED SENTENCE, A SUSPENDED SENTENCE, PLACED ON PROBATION, OR FINED IN ANY POLICE OR COURT ACTION, OTHER THAN A PARKING VIOLATION? THIS ALSO INCLUDES LISTING ALL TRAFFIC VIOLATIONS. ANSWER YES OR NO IN YOUR OWN HANDWRITING. IF YOUR ANSWER IS YES, A COMPLETE STATEMENT OF EACH SUCH INSTANCE MUST BE LISTED BELOW. ALSO INCLUDE ANY VIOLATION THAT MAY HAVE BEEN EXPUNGED. 16. HAVE YOU EVER FILED FOR BANKRUPTCY PROTECTION, OR HAD ANY FORECLOSURE PROCEEDINGS CONDUCTED AGAINST YOU? IF YES, PLEASE EXPLAIN, AND INCLUDE THE COURT OF RECORD.

4 THE RHODE ISLAND MUNICIPAL POLICE TRAINING ACADEMY S BASIC WATER RESCUE PROGRAM REQUIRES RECRUITS TO SUCCESSFULLY COMPLETE THE FOLLOWING WATER TASKS TO SATISFY THE GRADUATION REQUIREMENTS FROM THE RHODE ISLAND MUNICIPAL POLICE TRAINING ACADEMY. YOU MUST BE ABLE TO ANSWER AFFIRMATIVELY TO THE FOLLOWING QUESTIONS IN ORDER TO SUBMIT THE APPLICATION AND CONTINUE IN THE HIRING PROCESS. FAILURE TO SATISFY THESE REQUIREMENTS DURING THE ACADEMY WILL RESULT IN REVOCATION OF EMPLOYMENT OPPORTUNITIES WITH THE CITY OF PAWTUCKET. CAN YOU SWIM 200 YARDS CONTINOUSLY (8 LAPS OF OLYMPIC POOL) USING 100 YARDS OF AN APPROACH STROKE (CRAWL OR BREAST) AND 100 YARDS OF A TOW STROKE (SIDESTROKE OR ELEMENTARY BACKSTROKE)? CA N YOU TREAD WATER FOR 10 MINUTES? CAN YOU SURFACE DIVE TO A DEPTH OF 7-12 FEET TO RETRIEVE A 40LB OBJECT? CAN YOU SWIM A DISTANCE OF 30 FEET OR 5 BODY LENGTHS UNDERWATER? I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal/disqualification. I authorize the investigation of all statements contained herein, as well as authorizing all persons listed herein to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing any of this information to you. DATE: SIGNATURE of APPLICANT AN EQUAL OPPORTUNITY EMPLOYER

5 CITY OF PAWTUCKET DATE: AFFIRMATIVE ACTION AND EQUAL EMPLOYMENT *TO BE COMPLETED BY APPLICANT ONLY* NAME: ADDRESS: STREET CITY STATE ZIP * Pursuant to the 1964 Civil Rights Act, any information provided by the applicant to the City is done so on a strictly voluntary basis, and in order to assist us in our efforts, we ask you to provide the below voluntary information. MALE FEMALE POSITION SOUGHT Please check any that apply: WHITE BLACK HISPANIC AMERICAN INDIAN/ALASKAN NATIVE ASIAN AMERICAN/PACIFIC ISLANDER DISABLED DISABLED VETERAN VIETNAM ERA VETERAN WHITE: ( not of Hispanic Origin) All persons having origins in any of the original people of Europe, North America or the Middle East BLACK: (not of Hispanic Origin) All persons having origins in any of the Black racial groups in Africa HISPANIC: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. AMERICAN INDIAN OR ALASKAN NATIVE: All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition. ASIAN OR PACIFIC ISLANDER: All persons having origins in any of the original people of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands and Samoa. DISABLED: All persons with a physical or mental disability that substantially impairs or restricts one or more of such major life activities as walking, seeing, hearing, speaking, working or learning. A history of such disability, or the belief on the part of others that a person has such a disability, whether it is so or not, also is recognized as a handicap by the regulation The City of Pawtucket is committed to taking Affirmative Action to ensure equitable employment opportunities and equitable participation at all levels of the City government workforce by the various segments of the Community. The City will consider each applicant for employment or promotion specifically given consideration of his or her qualification and ability to perform work and to eliminate and prevent discrimination on the basis of race, religion, color, sex, age, handicap or national origin.