Police Reserve Unit Application Form
Please Fill Out the Form Below to Submit Your Job Application!
Application Information
We appreciate your interest in seeking employment with the City of La Crescent. Completing this application will assist us in understanding your work history and education background. The City of La Crescent is an Equal Opportunity/Affirmative Action employer. The City follows the principles of non-discrimination in employment, complying with all federal, state, and local laws and requires all City employees to comply with such laws. REVIEW THE QUALIFICATION REQUIREMENTS CAREFULLY. Applicants are accepted for the job posted and must be received by the closing date.
Date of Application
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Month
-
Day
Year
Date
Name
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First Name
Middle Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
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Please enter a valid phone number.
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Education History
Have you graduated from High School or received a GED?
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Yes
No
If yes, what High School did you attend and when did you graduate?
Have you attended a university, technical college, military academy, business or trade school, or received any post-secondary education?
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Yes
No
Education 1
School Name
Program
City
State
Graduation Date (or estimated graduation date)
Education 2
School Name
Program
City
State
Graduation Date (or estimated graduation date)
Education 3
School Name
Program
City
State
Graduation Date (or estimated graduation date)
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Skills/Licenses
List all skills you possess which are required for the job as stated in the job description, such as ability to operate specialized machinery or equipment, or professional registration or licensing. Indicate any training you have had which is directly related to the job for which you are applying.
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Criminal Conviction Disclosure
Have you ever been convicted of a misdemeanor, gross misdemeanor, or felony for which a jail sentence could have been or was imposed (do not include juvenile convictions or petty misdemeanors)? This information will not be used to bar you from employment but may be used to direct your interest to areas less related to the area of your conviction.
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Yes
No
If you answered yes, give full details here.
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Employment History
Please give accurate, complete, full-time and part-time record. Start with present or most recent employer. Be complete. Experience and training ratings are determined by the information you provide and your score is based upon it. DO NOT MARK APPLICATION AS "SEE RESUME." Account for all of your work and include volunteer experience.
Employer 1
Company/Employer Name and Location (city, state)
Position/Title
Phone
Dates of Employment
Direct Supervisor Name
Employer 2
Company/Employer Name and Location (city, state)
Position/Title
Phone
Dates of Employment
Direct Supervisor Name
Employer 3
Company/Employer Name and Location (city, state)
Position/Title
Phone
Dates of Employment
Direct Supervisor Name
Employer 4
Company/Employer Name and Location (city, state)
Position/Title
Phone
Dates of Employment
Direct Supervisor Name
Employer 5
Company/Employer Name and Location (city, state)
Position/Title
Phone
Dates of Employment
Direct Supervisor Name
Employer 6
Company/Employer Name and Location (city, state)
Position/Title
Phone
Dates of Employment
Direct Supervisor Name
Employer 7
Company/Employer Name and Location (city, state)
Position/Title
Phone
Dates of Employment
Direct Supervisor Name
Employer 8
Company/Employer Name and Location (city, state)
Position/Title
Phone
Dates of Employment
Direct Supervisor Name
Employer 9
Company/Employer Name and Location (city, state)
Position/Title
Phone
Dates of Employment
Direct Supervisor Name
Employer 10
Company/Employer Name and Location (city, state)
Position/Title
Phone
Dates of Employment
Direct Supervisor Name
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Employment Eligibility
Are you at least 18 years of age or, if not, can you provide required proof of your eligibility to work?
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Yes
No
Are you a US citizen or, if not, do you have permission to work in this country?
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Yes
No
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References
Provide three references (work or education related, do not list relatives)
Reference 1
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Full Name
Address
City and State
Phone
Occupation
Reference 2
*
Full Name
Address
City and State
Phone
Occupation
Reference 3
*
Full Name
Address
City and State
Phone
Occupation
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Additional Information
Applicants for the La Crescent Police Reserve Unit are requested to complete the following:
Please list all volunteer law enforcement experience, including dates of service:
Select the appropriate level of medical training that you have:
No medical training
Basic First Aid
CPR/AED
EMR (First Responder)
EMT
Higher than EMT
List all special certifications you have that pertain to law enforcement:
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Optional Documents
If you have a cover letter and/or resume, you may upload it here. This is not required.
Cover Letter
Browse Files
Drag and drop files here
Choose a file
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of
Resume
Browse Files
Drag and drop files here
Choose a file
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of
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WAIVER AND RELEASE
I voluntarily agree to a background check and understand that any violation of internship guidelines may result in termination. I understand I may be exposed to sensitive situations and agree to remain in the patrol unit during incidents unless directed otherwise. I release the City of La Crescent, its employees, and representatives from any liability forinjury or damages incurred during this internship.
AUTHORIZATION TO RELEASE INFORMATION
Pursuant to Minnesota Statute 13.05, Subd. 4, I authorize the City of La Crescent and its agents to obtain information about me, including data classified as private, for the purpose of evaluating my suitability for internship. A photocopy of this authorization shall be treated as the original.
FINAL SUBMIT
Please review your application before submitting! By clicking submit, you are acknowledging that the answers you provided in this application are true and complete to the best of your knowledge.
Please verify that you are human
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Submit
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