Application for Employment Palos Heights Police Officer

Transcription

1 City of Palos Heights Board of Fire and Police Commissioners 7607 W. College Drive Palos Heights, IL (708) Commissioners Chairman Edwin Gausselin John Sexton Chester Placzek Application for Employment Palos Heights Police Officer In the following pages, the Board of Fire and Police Commissioners of Palos Heights, Illinois, have outlined points that are important to you as an applicant for the position of Police Officer for the City of Palos Heights Police Department. The following pages contain the basic requirements that must be met and or completed before filing an application with the Board of Fire and Police Commissioners. The procedures an applicant will follow and the process the Board has delineated is explained in the following pages. Chairman Edwin Gausselin The City of Palos Heights is an equal opportunity employer.

2 CITY OF PALOS HEIGHTS BOARD OF FIRE AND POLICE COMMISSIONERS Required Documents The Board of Fire and Police Commissioners of Palos Heights, Illinois require that the following documents accompany your completed, hand written application before any testing process is administered: A photocopy of the applicant s birth certificate A photocopy of the applicant s Associate or Bachelors Degree Certificate, college transcript or law enforcement certification. Signed and dated forms from this packet: Policy form, Agreement to Abide and Release of Claims A photocopy of the applicant s Report of Separation from Active Duty form (DDForm 214) if applicable. All documents will become the property of the Board of Fire and Police Commissioners of Palos Heights, Illinois. There will not be any deviations or exceptions to any requirements.

3 City of Palos Heights Board of Fire and Police Commissioners 7607 West College Drive Palos Heights, IL (708) Application for Employment APP # Complete in your own handwriting Today s Date: Name Last First Middle Under Illinois law and City of Palos Heights policy, applicants for the position of law enforcement officer must be between the ages of twenty-one (21) and thirty-four (34). Proof of age will be required as a condition of employment. Do you comply with these age requirements? Yes No Note: Certain exceptions apply to the above-referenced age requirements for applicants, including but not limited to certain applicants who have active military duty experience or certain applicants who currently serve or formerly served as a law enforcement officer or fire fighter. If you feel you may apply for one of these exceptions to the age requirements, contact the Human Resources Department. Street City State Zip Please list any other addresses used within the last seven (7) years: Street City State Zip Street City State Zip Street City State Zip Home Telephone # Cell # Are you a U.S. Citizen? Page 1 of 4

4 Do you have a valid Illinois Driver's License? or valid out-of-state Driver s License? Driver s License # and class Do you personally feel you can pass a rigid and exhaustive background investigation conducted by the Department? Have you ever been convicted of a felony offense or a crime involving moral turpitude? If yes, please explain: Have you ever been convicted of or arrested for a misdemeanor offense? If yes, please explain: How did you learn of this test? (Referral source) Have you ever been employed by the City of Palos Heights? If so, where and when? Do you have any relatives who are currently employed by the City of Palos Heights? If yes, who? Are you a veteran of the U.S. Military? Yes _ No If yes, branch: Rank at discharge: If discharge was not honorable, please explain: Page 2 of 4

5 Education, Training and Experience High School Name/ Circle Last year Completed Degree Earned? Diploma Colleges, Vocational or Business Schools and Other Higher Education Last year attended: Last year Attended: Last year Attended: If you earned an Associate s Degree, in which academic field did you earn the degree? List any courses, seminars, workshops, training sessions, etc., that might relate to the type of work or position you are applying for: Please list any other experiences or training that you feel may especially qualify you for employment with the Palos Heights Police Department: Page 3 of 4

6 Employment History Begin with your present and most recent job and list fully and accurately the details of each position. Employer Name & address Job Title From Mo./Yr. To Mo./Yr. Starting Salary Ending Salary Reason for leaving Description of Duties Did you supervise employees? If yes, how many? Name & Title of your immediate supervisor May we contact this employer? Telephone number Employer Name & address Job Title From Mo./Yr. To Mo./Yr. Starting Salary Ending Salary Reason for leaving Description of Duties Did you supervise employees? If yes, how many? Name & Title of your immediate supervisor May we contact this employer? Telephone number Employer Name & address Job Title From Mo./Yr. To Mo./Yr. Starting Salary Ending Salary Reason for leaving Description of Duties Did you supervise employees? If yes, how many? Name & Title of your immediate supervisor May we contact this employer? Telephone number CHARACTER REFERENCES List three persons other than former employers or relatives who would have knowledge of your qualifications for the position for which you are applying. NAME AND OCCUPATION ADDRESS PHONE NUMBER Page 4 of 4

7 CITY OF PALOS HEIGHTS BOARD OF FIRE AND POLICE COMMISSIONERS Agreement to Abide By Rules and Regulations I, the undersigned hereby agree to abide by all rules and regulations of the Board of Fire and Police Commissioners of the City of Palos Heights, Illinois during and after any examination, during any probationary period to which I might be appointed, or as a regular member of the Palos Heights Police Department. Dated this day of, Signature Name (please print)

8 CITY OF PALOS HEIGHTS BOARD OF FIRE AND POLICE COMMISSIONERS Policy Form I understand it is the policy of the City of Palos Heights Board of Fire and Police Commissioners that the results of any examination I take in this upcoming police officer testing process are the property of the Board of Fire and Police Commissioners and, as such, the Board is under no obligation to share the results of any of the examinations with the candidate. Dated this day of, Signature Name (please print)

9 CITY OF PALOS HEIGHTS BOARD OF FIRE AND POLICE COMMISSIONERS Release of All Claims This release is to be signed by the applicant, and his or her spouse. Know all men by these presents, that I (we), the undersigned, individually and for our executors, administrators, heirs, agents, servants, employees, successors and assigns, and each and everyone of them, for the consideration of making application to the Board of Fire and Police Commissioners of Palos Heights, Illinois, for the examination for the appointment of a position on the Palos Heights Police Department, and for being permitted to participate therein and for other good and valuable considerations, the receipt and sufficiency of which are hereby acknowledged, do for myself (ourselves), individually and for our executors, administrator, heirs, agents, servants, employees, successors and assigns, and each and everyone of them: Do hereby remise, release and forever discharge the Board of Fire and Police Commissioners of Palos Heights, Illinois, and the City of Palos Heights, Illinois, an Illinois municipal corporation, and its agents, servants, employees, officers, officials, insurers, successors, and assigns and each and everyone of them, from any and all liability, claims, demands, actions and causes of actions which I (we) have or may have, individually and for my (our) executors, administrator, heirs, agents, servants, employees, successors and assigns, and each and everyone of them, against the Board of Fire and Police Commissioners of Palos Heights, Illinois and the City of Palos Heights, Illinois, an Illinois municipal corporation, and its agents, servants, employees, officers, officials, insurers, successors, and assigns and each and everyone of them, arising or growing out of any accident, casualty or event from the beginning of the world, including but without limiting the generality of the foregoing, all claims, demands, actions or causes of action and obligation of every kind and nature for all known and unknown, anticipated, unanticipated personal injuries, property damage or any other injury or damage in connection with the application aforesaid and the examinations and tests, and procedures and programs in connection therewith. I(we) do hereby certify and represent unto the Board of Fire and Police Commissioners of Palos Heights, Illinois and City of Palos Heights, Illinois, that I (we) are physically and mentally fit and able to participate in the examinations and test, and procedures and programs in connection with the aforesaid application. I (we) have read this release of all claims, understand it and I (we) intend to be bound by it. In witness whereof, I (we) have set my (our) hand(s) and seal(s) this day of, Applicant Signature Applicant Printed Name Spouse Signature Spouse Printed Name