Police Department Employment Application

Name *

First

Last

Position Title *

the position you are applying for.

Date / Time

Date

Time

When will you be available for employment? *

What type of employment are you seeking? *

Full-Time
Part-Time
Temporary

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone Number *

Are you 18 years or older? *

If no, what is your birth date?

Please record your work history below (past 3-5 positions, if applicable). Please indicate the following for each job: 1) Job Title, 2) Starting Salary, 3) Last Salary, 4) Date Employed, 5) Date Separated, 6) Employer or Company, 7) Employer or Company Address, 8) Name and Title of most current supervisor, 9) Length of employment, 10) Duties in order of importance, 11) reason for leaving or desiring a change *

Have you had disciplinary action taken against you in the past 12 months? *

If yes, please explain (a "yes" does not automatically disqualify you)

Have you ever been dismissed or forced to resign from any job held? *

If yes, please explain (a "yes" does not automatically disqualify you)

May we contact your present employer for reference prior to an interview (if granted)? *

CERTIFICATION AND RELEASE-  To the best of my knowledge and belief, the information given truly represents my background and experience. I understand that if I have knowingly or negligently misrepresented, falsified or omitted any information during the application process, or have made any changes to the format or wording of this application form, I may be disqualified for employment consideration or dismissed from employment with the City.  I authorize my current and former employers to give any information regarding me or my employment, whether or not it is on their records. I hereby release them from any damage whatsoever for issuing same.  I also authorize educational institutions which I attended to reveal my scholastic ratings, as well as degrees or certificates earned, to the City of Bessemer City; and associations, registration and licensing boards and to others to furnish whatever detail is available concerning my qualifications. Notwithstanding any provision of State or Federal law, I expressly waive any right I have to review information the City receives from an employer or educational institution under a promise of confidentiality.  I also permit the City of Bessemer City to conduct a Police, Court, Credit and/or Motor Vehicle Records Investigation of my background where related to the job for which I am applying.  I understand that if I apply or have applied for certain jobs, I may be tested for drug and alcohol use to determine if I am currently using or abusing these substances. I consent to the testing and understand that the results could preclude my appointment.  I understand and acknowledge that should I be employed by the City of Bessemer City, then I serve "at will". This means that I may be terminated at any time. I further understand that this "at will" employment relationship may not be changed by any written document unless such change is specifically approved by the City Manager *

Agree

Police Department Employment Application

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