Stinesville Police Department Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Stinesville Police Department • PO Box 66, Stinesville IN 47464 • Chief David Boone

Stinesville Police Reserve LEO Winter 2021/2022 Process

Full Legal Name *

D0B *

YYYY

ILEA Certification Status *

Tier 1 (In Good Standing)

Tier 2 (In Good Standing)

40 Hour Pre-Basic (In Good Standing)

Previously certified, however more than 24 months since last sworn posistion

No Prior Certification

List all other names you have used (include nicknames, maiden name, etc.)

Address Street City State Zip Code *

Phone Number *

Email Address *

Drivers License Number (IN) *

List all other states in which you have had a driver’s license issued to you

Education Record

High School Name *

High School Address *

High School Graduation Date *

YYYY

College or University Name

College or University Address

College or University Graduation Date

College or University Degrees Earned

List any awards, honors, citations, athletic endeavors, and/or any other special recognition you received during our academic career:

List any special abilities (computer skills, etc), special interests or hobbies that you have:

Organizations and Volunteering

List any club, society, or organization you now or you have ever been a member of?

List below all volunteer activities you are, or have been involved with, to include civic activities, volunteer fire fighting, police or sheriff reserves, etc. Include dates and positions held.

Selective Service / Military Record

Are you registered with the Selective Service? *

Yes

N/A

Have you ever served in any branch of the Armed Forces? *

Yes

List all periods of Armed Forces service with dates and discharge types:

Employment History

List your work experience, starting with the most recent, include summer and part-time employment. If unemployed for a period of time, indicate such, setting forth the dates of unemployment. Account for all time:

Employment 1 List: Name and address of employer, dates of employment, position and responsibilities, name of supervisor with telephone number.

Employment 2 List: Name and address of employer, dates of employment, position and responsibilities, name of supervisor with telephone number.

Employment 3 List: Name and address of employer, dates of employment, position and responsibilities, name of supervisor with telephone number.

Employment 4 List: Name and address of employer, dates of employment, position and responsibilities, name of supervisor with telephone number.

Employment 5 List: Name and address of employer, dates of employment, position and responsibilities, name of supervisor with telephone number.

Additional Qualifications

Summarize any special job related skills and qualifications acquired from employment or other experience.

Character References *

List three references, not related to you. Include complete name, occupation, years acquainted, and contact phone number.

Additional Information

State below any additional information you feel may be helpful to us in considering your application.

Applicant Statement and Signature *

I certify that the answers contained within this application for employment are true and complete to the best of my knowledge. By signing below I hereby authorize investigation of all statements contained within this application for employment as may be necessary in arriving at an employment decision. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that any false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. Type your Full Name below:

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms