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BSPA Recruitment Contact Sheet
Are you interested in joining a Cleveland public safety force? Fill out this contact sheet, and The Black Shield Police Association will reach back out to you with next steps, provide mentorship opportunities and more information.
All responses on this form will be confidential. If you have any questions, please email us at
info@theblackshield.org
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Email
*
Your email
GENERAL QUESTIONS
Please answer truthfully - no information will be shared, all will remain confidential.
What is your first and last name?
*
Your answer
What gender do you most closely identify with?
*
Female
Male
Gender non-conforming
Prefer not to say
What is your HOME address?
*
Your answer
What is your phone number?
*
Your answer
What is your email address?
*
Your answer
What is your highest level of education?
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General Educational Degree or "G.E.D"
High School Diploma
Some College
Associate's Degree
Bachelor's Degree
Some Graduate school
Master's Degree (M.B.A. etc.)
Ph.D. / J.D.
Which public safety department are you most interested in joining or learning more information about? (Please do not check more than 2 choices)
*
Cleveland Division of Police
Cleveland Division of Fire
Cleveland Division of Emergency Medical Services
Cuyahoga County Department of Corrections
Cuyahoga County Sheriff's Department
911 Operator
Bailiff
Clerk of Court
Vehicle Maintenance
General Public Safety
Required
PROFESSIONAL PUBLIC SAFETY EXPERIENCE
The following section details if you have had professional public safety experience, including camps, professional certifications, professional development, law enforcement or public safety forces etc.
Do you have related police or public safety professional experience?
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Yes
No
If you answered "YES", please describe in 1 to 2 sentences.
Your answer
In 1 to 2 sentences: Why do you want to be a public safety official?
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Your answer
LEGAL ISSUES
Please answer truthfully - no information will be shared, all will remain confidential.
Do you have any criminal offenses (active or former)?
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Yes
No
If you answered "YES", please check all that apply.
*
Traffic Tickets (Unpaid)
Parking Citations / Moving Violations
Vehicle Accidents (At Fault or Victim)
General Criminal Reports (Victim or Suspect)
Robbery or Burglary
Assault or Battery
Domestic Violence
None
Other:
Required
PHYSICAL FITNESS
The following questions concern your own personal physical fitness. Do not overestimate your abilities - please answer truthfully - no information will be shared, all will remain confidential.
What is your estimate time for a 1.5 mile?
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Over 20 minutes
19:30 to 20:30
18:30 to 19:30
17:30 to 16:30
16:30 to 15:30
15:30 to 14:30
14:30 to 13:30
13:30 to 12:30
12:30 to 11:30
11:30 to 10:30
10:30 to 9:30
9:30 to 8:30
Less than 8 minutes
How many push-ups are you able to do, without stopping, in 1 minute?
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5 to 10
11 to 15
16 to 20
21 to 25
26 to 30
31 to 35
36 to 40
41 to 45
Over 50
How many sit-ups are you able to do, without stopping, in 1 minute?
*
5 to 10
11 to 15
16 to 20
21 to 25
26 to 30
31 to 35
36 to 40
41 to 45
Over 50
How would you rate your vision? (If you wear glasses/contacts, please include)
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Poor, it is difficult for me to see.
1
2
3
4
5
Excellent, I have great vision.
How would you rate your health overall?
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Poor health
1
2
3
4
5
Excellent health
A copy of your responses will be emailed to the address you provided.
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