Sworn Police Officer Application

Sworn Police Officer Application
Minimum Requirements to be considered for appointment to the Southport Police Department:

All applicants:
1. Must be a minimum of twenty-one (21) years of age at time of application.
2. Must be a high School graduate or have a GED.
3. Must be a citizen of the United States of America prior to the date of making application.
4. Must have and maintain a valid, non-suspended, non-expired, non-conditional, non-revoked Driver’s License.
5. Must notify Southport Police Department of any changes to your address, phone number.
6. Must be able to perform the essential functions of the job of patrol officer in a safe manner with or without a reasonable accommodation.
7. Must not have been found guilty of a felony in any Court which has not been annulled, expunged or sealed by a court.

APPLICATION REQUIREMENTS
All of the following documents MUST be included with this application for consideration.
1. Birth Certificate
2. High School Diploma or equivalent and transcripts
3. College or University Degree Transcript (if applicable)
4. DD214 (member 4 copy) and Citations (for those applicants with military background).
5. Law Enforcement Academy Graduation Certificate and Training Records (if applicable)
6. Copy of Driver’s License (front and back)
7. Copy of Social Security Card
8. Any Court Order requesting name change (if applicable)
9. Two (2) recent facial photographs
10. Current Resume

NO APPLICATION WIL BE CONSIDERED UNLESS ALL THE ABOVE ITEMS ARE INCLUDED WITH THE APPLICATION DIRECTIONS

1. Read each question carefully before answering.
2. Be certain that each question is answered COMPLETELY and CORRECTLY. If a question does not apply to you, write “N/A” (not applicable) in the space. Leave no blank spaces.

VERIFICATION OF INFORMATION

The information requested on this questionnaire will be viewed by those who will be considering your application for employment with the Southport Police Department. An extensive background investigation will be conducted into your personal history.

Any FALSE, MISLEADING or INCOMPLETE information substituted as accurate information will be grounds to disqualify you from further consideration in the application process with the Southport Police Department.

I confirm that I have read and understand the above and that all statements and documents presented to the Southport Police Department are true, correct, and complete and made in good faith.
Applicant Name*

First NameMiddle NameLast Name
Applicant Signature*

Clear
Date*

MonthDayYear
Date
This application must be completed entirely by the applicant only; however, the applicant may request any needed accommodation to participant in the applicant process unless such accommodation causes undue hardship to the Southport Police Department. All information will be regarded as confidential. This application will be given every consideration, but its receipt does not imply that the applicant will be employed.

Because of the sensitive and important nature of law enforcement, the Southport Police Department must select employees who possess the best physical, mental, moral, and emotional character for the performance of these duties. In order to best ascertain who those individuals are, it is necessary to gather as much information as possible about each applicant which may have bearing on his/her ability to perform the duties required with or without an accommodation. Several questions in this application are designed to give the department a complete background on each applicant. Unless specifically noted, no answer shall act as an automatic bar to selection but will be considered along with attendant facts. No question is intended to secure information to be used for unlawful discrimination.

DO NOT MISSTATE OR OMIT MATERIAL AS INFORMATION MADE HEREIN IS SUBJECT TO VERIFICATION TO DETERMINE YOUR QUALIFICATIONS FOR EMPLOYMENT

POLICY STATEMENT ON EMPLOYMENT OF EX-OFFENDERS
Consideration for employment of ex-offenders shall be given without regard to race, color, sex, religion, creed, national origin, ancestry, handicap as defined by law, political affiliation, except when age, sex or physical requirements constitute a bona fide occupation qualification necessary to proper and efficient administration, or for the health, safety and welfare of the applicant and others, or as provided by the law. The term “ex-offender” as used herein, refers to anyone convicted of any criminal statute or military offense while in the service.

FELONY CONVICTIONS
Any individual convicted of a felony shall be ineligible for employment by the Southport Police Department. A felony is defined by Indiana Law (35-50-2-1) as any offense for which a person may receive more than one (1) year of confinement in a state or federal institution.

EVALUATION
With respect to all other criminal convictions which are not felonies, is each case the department will consider whether the prior criminal conviction or military offense conviction of the applicant will have a bearing on the applicant’s job performance or tend to measure job capability. The date and nature of offense, the requirements of the position which is being applied for, as well as the applicant’s other qualifications will be considerations.

CONFIDENTIALITY
As a matter of policy, every effort will be made to keep the applicant’s criminal record confidential. During the selection and placement process, it will be necessary to inform the appropriate persons participating in the process of the applicant’s criminal records.

POLICY STATEMENT ON BACKGROUND INVESTIGATIONS
It is a policy of the Southport Police Department to recruit qualified individuals for positions in the department. In pursuing this goal, a background investigation of each applicant is conducted with respect to factors that may have a bearing upon the applicant’s job performance or tend to measure job capability as a member of the Southport Police Department.

Members of the Department are public servants. Police Officers are placed in situations of public trust and must be of high integrity and character. A police officer’s job often involves critical and dangerous situations and he/she should not be prone to external pressures that would affect his/her ability to perform the job.

Accordingly, the following items and the circumstances surrounding such items are reviewed:
1. Contents and completeness of employment application.
2. Driver’s responsibility (copy of driving summary furnished by the Indiana Bureau of Motor Vehicles).
3. Former employment.
4. Financial condition.
5. Criminal record of applicant pursuant to “Policy Statement on Employment of “Ex-Offenders”.
6. Personal character references.
7. Personal history of applicant.

A negative finding non any one of these factors shall not, in and of itself, be reason for an automatic rejection of an applicant. Instead, the circumstances underlying such matters will be considered as they relate to the applicant’s ability to perform the job. The date and circumstances surrounding any negative findings in the background investigation, the requirements of the position, as will as the applicant’s other qualifications, will be considered.

The background investigation phase of the hiring process shall be base upon objective, factual findings and any required subjective determination shall be in accordance with the aforementioned policy and conducted in such a manner as to the discriminate on the basis of race, color, sex, religion, creed, national origin, ancestry, handicap as defined by law, or political affiliation, except when age, sex or physical requirement constitute a bona fide occupational qualification necessary to proper and efficient administration, or for the health, safety and welfare of the applicant and others, or as provided by law.

CHALLENGE PROCESS
Any potentially detrimental or negative information discovered during the background investigation phase of the application process shall be subject to review by the applicant. Incorrect information obtained as a result of the investigation may be challenged by the applicant by submitting the appropriate written request to the originating agency or appropriate authority.
Name*

First NameMiddle NameLast Name
Signature*

Clear
Date*

MonthDayYear
Date

Personal Information
Name*

First NameMiddle NameLast Name
Please list any other names you have used:
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number*
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Driver's License Number*
Driver's License State:*
Driver's License Type:*
Place of Birth (City, State, County)*

Employment History

Give employment record as completely as possible listing current or most recent employer first. Show unemployed or self-employed periods and indicate dates and comment on each period. Include part time or summer work. Please include the last 5 years of employment.
Please Upload Resume

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Current Employer
Employer Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Job Title*
Supervisor*
Dates of Employment:*
Type of Business:*
Description of Duties*
Reason for Leaving:*
May we contact this employer?*

YesNo
Previous Employer 1
Employer Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Job Title
Supervisor
Dates of Employment:
Month,Year-Month,Year
Type of Business:
Description of Duties
Reason for Leaving:
May we contact this employer?

YesNo
Previous Employer 2
Employer Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Job Title
Supervisor
Dates of Employment:
Type of Business:
Description of Duties
Reason for Leaving:
May we contact this employer?

YesNo
Please list any additional employment

References

List three people we may contact who are qualified to evaluate your capabilities. Do not include relatives. List Name, Occupation, Years Known, Address, Phone Number
Reference 1
Name*

First NameMiddle NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation*
Years Known*
Reference 2
Name*

First NameMiddle NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation*
Years Known*
Reference 3
Name*

First NameMiddle NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation*
Years Known*

Residential History

List all residences where you have lived during the past ten years. Begin with your present address and work backwards.
Current Address
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list any additional addresses:

Affiliations

Please list, in the space provided below, any Groups, Organizations, and/or Internet sites or Message boards to which you are a member.*

	Name	Username
Group/Organization
Group/Organization
Group/Organization
Group/Organization
Group/Organization
Group/Organization
Group/Organization
Group/Organization
Group/Organization
Group/Organization

Are you now or have you ever been a member of any organization, association, movement, group, or combination of persons which advocates the overthrowing of our constitutional form of government, or which has adopted the policy of advocating or approving the Commission or acts of force or violence to deny States or which seek to alter the form of government of the United States by unconstitutional means?*

YesNo
Please Explain*

Release Forms
AUTHORIZATION AND CONSENT FOR RELEASE OF PERSONAL INFORMATION

As part of a normal procedure for processing academy applications, The Southport Police Department conducts background checks on potential academy cadets. In order to continue the application process, a signed authorization and consent for release of personal information form is required.

I, the applicant listed below, hereby authorize The Southport Police Department, and/or its agents to fully investigate my background, which I understand may include information regarding my references, character, past employment, education, driving record, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment now and, if applicable, during my attendance at The Southport Police Academy.

I hereby authorize and request any prior or present employer, law enforcement agency, educational institution or other individuals or entities having personal data about me to furnish The Southport Police Department or any of The Southport Police Department’s agents, with any and all records, files and other information (including police records and juvenile records) in their possession with respect to me, in connection with my application for attendance at the Southport Police Academy.

Further, I hereby release from any and all liability and hold harmless all persons, institutions, or corporations supplying this information to The Southport Police Department, and release from any and all liability and hold harmless The Southport Police Department and its agents, from receiving and using such information.

I understand and acknowledge that this Authorization is not an express or implied contract of employment nor shall it be interpreted as such. The following is my true and complete legal name and all information contained herein is true and correct to the best of my knowledge. I also knowledge that a facsimile (FAX) or photographic copy of this Release Agreement is as effective as the original:

This Release Authorization is valid for one (1) year from the date set forth below.
Applicant Signature*

Clear
Today's Date*

MonthDayYear
Date
Applicant Legal Name*

First NameMiddle NameLast Name
Social Security Number*
Date of Birth*

MonthDayYear
Date
Maiden Name
Other Last Names Used
WAIVER OF LIABILITY AND RELEASE FORM

In consideration of the Southport Police Department and the City of Southport, Indiana, hereinafter referred to as the Agency, processing my application for employment, I the undersigned applicant hereby irrevocably agree to the following term and conditions:

1. The term “background investigation” as used in this document refers to any and all information and sources of information that the Agency, in its sole discretion, may deem necessary to obtain or contact, to determine my fitness as a candidate for employment with the Agency.
2. I hereby release from liability and promise to hold harmless under any and all possible causes of legal action any officer, agency, or employee of the Agency who may conduct my background investigation.
3. I hereby release from liability and promise to hold harmless under any and all possible causes of legal action, any and all person and entities who shall furnish any information or opinions to the officers, agents, or employees of the Agency who conduct my background investigation.
4. I authorize any person or entity contacted by the Agency’s officers, agents, or employees during the course of my background investigation, to furnish such officer, agents, or employees any information opinions they may have, and hereby expressly waive any and all legal privileges, the clergyman – penitent privilege, the husband-wife privilege, and the accountant – client privilege.
5. I hereby release from liability and promise to hold harmless, under any and all possible causes of legal action, the political subdivision, the Agency or any of its officers, agents, or employees for any statements, acts or omissions in the course of my background check.
6. I expressly waive all of my legal rights and causes of actions to the extent that the Agency background check may violate or infringe upon these legal rights and causes of action.
7. I expressly agree that I will never, under any circumstances, attempt to obtain the results of my background investigation as conducted by the Agency, realizing such information must be necessity remain confidential.

DO NOT SIGN BEFORE READING

This release from liability given by me to the political division, the Agency, its officers, agents and employees, and all others as mentioned above, shall apply to my right of action of any nature whatsoever that might accrue to myself, my heirs, or my personal representative.
Applicant Legal Name*

First NameMiddle NameLast Name
Driver's License Number*
Driver's License State*
Social Security Number*
Date of Birth*

MonthDayYear
Date
Applicant Signature*

Clear
Today's Date*

MonthDayYear
Date
Credit Information Release

Consumer Report Disclosure

By this Document, the City of Southport discloses to you that a consumer report may be obtained for employment purposes as part of the pre-employment background investigation and at any time during the employment. Please sign below to signify receipt of the foregoing disclosure.
Applicant Legal Name*

First NameMiddle NameLast Name
Applicant Signature*

Clear
Today's Date*

MonthDayYear
Date
Consumer Report Authorization

This document shall authorize the procurement of a consumer report by the City of Southport as part of the pre-employment background investigation. If hired, this authorization shall remain on file and shall serve as an ongoing authorization for the City of Southport to procure consumer reports at any time during my employment period.
Applicant Legal Name*

First NameMiddle NameLast Name
Applicant Signature*

Clear
Today's Date*

MonthDayYear
Date

Essay
Please respond to the following questions in essay format:
- Why do you want to be a Police Officer?
- Why do you want to work for the Southport Police Department
- What does community policing mean to you?
You may type your response in the field below or upload a document to this page.
Please Type Response Below*
Upload Essay Here

*Optional
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Document Upload

Please upload all relevant documents. If you do not wish to upload these documents now, you must bring them to Southport Police Headquarters before your application can be processed
Photo ID

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Social Security Card

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Birth Certificate

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Educational Records

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Training Records

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Finalize and Submit

Please review all entries before submitting application.
Should be Empty:

Sworn Police Officer Application

Personal Information

Questionnaire

Employment History

Current Employer

Previous Employer 1

Previous Employer 2

Education and Military

High School

College

Military Experience

References

Reference 1

Reference 2

Reference 3

Residential History

Current Address

Previous Address

Previous Address

Previous Address

Previous Address

Affiliations

Release Forms

Credit Information Release

Consumer Report Disclosure

Essay

Document Upload

Finalize and Submit