Titusville Police Application October 2025

CITY OF TITUSVILLE POLICE DEPARTMENT

POLICE OFFICER APPLICATION
Name*

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Alias
Alias(es), Nickname(s), Maiden Name
United States Citizen*
Selective Service Number*
Selective Service
Operating License Number*
Driver's License and State
Has your driver's license ever been suspended/revoked?*
If your driver's license has been suspended, please list the reason why:

RESIDENCES

List all for past ten years beginning with current. (This includes temporary housing, college, residing with friends/family, etc.)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If additional space is needed for residences, please contact Detective Anderson at (814) 827-1890 ext 4.

FAMILY

List in order showing relationship: parents, guardians, stepparents, foster parents, in-laws, brothers, sisters, stepbrothers, stepsisters and children. Include others you have resided with.
Father*
Address and Phone Number*
Mother*
Address and Phone Number*
Spouse
List Name and Relationship
Address and Phone Number
Other
List Name and Relationship
Address and Phone Number
Other
List Name and Relationship
Address and Phone Number
Other
List Name and Relationship
Address and Phone Number
Other
List Name and Relationship
Address and Phone Number
Other
List Name and Relationship
Address and Phone Number
Other
List Name and Relationship
Address and Phone Number

CRIMINAL RECORD AND FINANCIAL STATUS

List all financial accounts that you have held in the last seven (7) years.
Have you ever been convicted of a misdemeanor, felony or greater criminal violation?*
If yes, state violation, court of jurisdiction and date of conviction. If no, please enter "N/A".*
Have you ever used a controlled substance (Cocaine, Heroin, Methamphetamine, Marijuana, Adderall, Crack, Crack-Cocaine, etc.?)
Please indicate YES or NO, followed by an explanation if yes.
Do you have any income from any other source other than your principal occupation?*
If yes, state how much, how often and the source
Name and address of financial institution*
Type of account*
Checking, Savings, Other
Name and address of financial institution
Type of account
Checking, Savings, Other
Name and address of financial institution
Type of account
Checking, Savings, Other

PAST AND PRESENT MEMBERSHIP AND ORGANIZATIONS AND SUBVERSIVE ORGANIZATIONS
Name of Organization
Address, Type (Social, Fraternal, Professional), Office Held, Dates in Organization
Name of Organization
Address, Type (Social, Fraternal, Professional), Office Held, Dates in Organization
Are you now or have you ever been a member of any organization, movement, group, etc. in which advocates the overthrow of our constitutional government of the United States of America?*

EDUCATION

List all elementary, middle, high schools and colleges/universities (if none, please put N/A)
Elementary School*

Name

Address

Dates AttendedGraduated (Yes or No)
Middle School*

Name

Address

Dates AttendedGraduated (Yes or No)
High School*

Name

Address

Dates AttendedGraduated (Yes or No)
College/University*

Name

Address

Dates AttendedGraduated (Yes or No)
Police Academy

Name

Address

Dates AttendedGraduated (Yes or No)

EMPLOYMENT

Begin with your current job and list your work history for the past ten (10) years, including part-time, temporary or seasonal employment, and all periods of unemployment. Should you run out of spaces, please indicate at bottom.
Current Employment*

Company's Name

Company's Address

Dates EmployedJob Title

Supervisor Name and Title
Supervisor Phone Number*
Annual Income*
Reason for leaving*
Employment

Company's Name

Company's Address

Dates EmployedJob Title

Supervisor Name and Title
Supervisor Phone Number
Annual Income
Reason for leaving
Employment

Company's Name

Company's Address

Dates EmployedJob Title

Supervisor Name and Title
Supervisor Phone Number
Annual Income
Reason for leaving
Employment

Company's Name

Company's Address

Dates EmployedJob Title

Supervisor Name and Title
Supervisor Phone Number
Annual Income
Reason for leaving
Employment

Company's Name

Company's Address

Dates EmployedJob Title

Supervisor Name and Title
Supervisor Phone Number
Annual Income
Reason for leaving
Employment

Company's Name

Company's Address

Dates EmployedJob Title

Supervisor Name and Title
Supervisor Phone Number
Annual Income
Reason for leaving
Employment

Company's Name

Company's Address

Dates EmployedJob Title

Supervisor Name and Title
Supervisor Phone Number
Annual Income
Reason for leaving
Are there more employers that would not fit on the application?*
Have you ever been discharged, asked to resign, furloughed, or put on inactive status for cause, or subject to disciplinary action while in any position (except military)?*
If yes, please explain:
Have you ever resigned after being informed your employer intended to discharge/terminate you for any reason?*
If yes, please explain:
Have you ever applied for a position with any other governmental agencies? If yes, give details.*
List agency name, location and year of application
I hereby declare that the above-mentioned employment records are accurate, and the particulars furnished by me, are true and correct.*
Name of the Application*

CHARACTER REFERENCE

List only character references who have definite knowledge of your qualifications for the position of application and have known a minimum of three years. Do not list relatives, former employers or persons living outside of the United States.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Years Known*
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Years Known*
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Years Known*
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Years Known*
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Years Known*
Are there any other incidents in your life not mentioned herein which may reflect upon your suitability to perform the duties which you may be called upon to take or which might require further explanation?*

MILITARY STATUS
Have you ever served in the U.S. Armed Forces?*
If yes, upload a copy of your DD-214/Separation Papers.
Do you claim veteran's preference? *
While in the military service, were you ever convicted for any crime graded as a misdemeanor, felony or greater offense? If yes, give date, place, law enforcing authority or type of court or court martial, charge and action taken for each incident, using separate sheet to record this information.
If yes, provide date, place, law enforcement agency and action taken
Are you presently a member of a U.S. Reserve or State National Guard Organization?*
If yes, list the following: Grade and Service Number, Service and Component, Station Address and Phone Number, Status and Indicate reserve obligation (if any)

NOTIFICATION PROCEDURE RELEASE
In the processing procedure required for applicants, it may become necessary to contact the applicant in the event they are being given further consideration for the position of police officer with the City of Titusville.

If conventional methods fail in attempting to contact the applicant, a certified/registered letter will be sent to the applicant's listed address on the application. Should the certified/registered letter be returned indicating that it was unclaimed or undeliverable, the applicant will be eliminated from further processing and consideration.

It is the applicant's responsibility to notify the City of Titusville, in writing, of the address change. By affixing your signature to this form, the applicant acknowledges that you have read and understood the contents in this procedure.
Signature*

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VERIFICATION AND APPLICANT BACKGROUND WAIVER
VERIFICATION

I certify that there are no misrepresentations, omissions or falsifications in the foregoing statements and answers and that the information I have provided in the application is true and correct to the best of my knowledge, belief and are made in good faith. I understand that any false statement contained therein is subject to the penalties prescribed by 18 PA. C.S.A. § 4904, relating to unsworn falsification to authorities.

APPLICANT BACKGROUND WAIVER

As an applicant for employment with the City of Titusville Police Department, I do hereby authorize the release of such information that may be requested by the Titusville Police Department concerning my background, character, education, medical history, employment history, credit and any or all other types of information and/or documents that may be requested by the Titusville Police during their reviewing my application for employment.
Name*

First NameMiddle NameLast Name
Social Security Number*
Signature*

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CONSENT TO OBTAIN CONSUMER REPORT
To: Applicant

RE: Notice of Possible Request for Consumer Report

This letter is to provide you notice that, for employment purposes, once you have provided your written consent, the City of Titusville may obtain a "Consumer Report" about you from one or more consumer reporting agencies.

Under Federal law, a Consumer Report is a report which includes information concerning your creditworthiness, credit standing, credit capacity, character, general reputation, personal characteristics or style of living. The City of Titusville may rely on information in your Consumer Report as one factor in making decisions regarding your possible employment with the City of Titusville. If you are hired by the City of Titusville, the Consent Form you signed will also authorize the City of Titusville to obtain Consumer Reports at any time during your employment. These reports may be one of the factors used by the City in future employment decisions.

CONSENT TO OBTAIN CONSUMER REPORT

The undersigned, in connection with an application for employment by the City of Titusville, hereby acknowledges receipt of a notice of the possibility that the City of Titusville may obtain one or more Consumer Reports about me for employment purposed, that I have carefully read and understand that notice, and that I understand that a review of one or more Consumer Reports by the City of Titusville may affect the decision whether or not employment is offered to me.

I hereby authorize the City of Titusville and provide my consent to order a Consumer Report about me from one or more consumer reporting agencies. I further authorize and consent to the use by the City of Titusville of one or more Consumer Reports in evaluating my application for employment, and, if hired, in connection with future decisions regarding my employment with the City of Titusville. Should I be hired by the City of Titusville, I hereby authorize the City of Titusville to obtain one or more Consumer Reports at any time during my term of employment with the City of Titusville. I authorize and consent to the use by the City of Titusville of these Consumer Reports as one factor in future decisions regarding my employment status with the City of Titusville.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number*
Phone Number*

Area CodePhone Number
Signature*

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AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION
The undersigned, pursuant to the Health Insurance Portability And Accountability Act (HIPPA) of 1996, hereby authorizes any hospital, physician, or health care facility that has treated me to release to the City of Titusville any and all records related to said treatment for the following state purpose: at my request.

This authorization shall be effective until duration of application process/separation from the City of Titusville.

I understand I have the right to revoke this authorization at any time by delivering a written revocation to the applicable health care provider. I understand that I may not revoke this authorization when the party using or disclosing protected health information has already acted in reliance on this authorization.

No treatment, payment or eligibility for benefits is conditioned upon the execution of this authorization form.

I understand and specifically acknowledge that there may be further disclosure of my protected health information by the recipient of any such information, which further disclosure will not be protected by the Heath Insurance Portability And Accountability Act.

I acknowledge receipt of a copy of this authorization as executed.
Signature*

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REFERENCE CHECKS
Having made application for employment with the City of Titusville, I request that its representative be informed of my work/school record. I authorize the investigation and release of all my non-medical official record(s)/personnel file(s) maintained by my present and prior employers and by institutions at which I was enrolled for some period of time in some course of study. I also request that persons contacted for the purpose of providing the City of Titusville information (including by not limited to opinions) relating to my application for employment at the City of Titusville cooperatively provide the information sought. This request applies to information and opinion relating to my: skills, abilities, trustworthiness, attendance, flexibility, diligence, aptitude for learning, effectiveness as a team player, planning and organizational abilities, oral and written communication abilities. Loyalty, need to be reprimanded, counseled or disciplined, etc. I fully and completely release any and all institutions and persons who/which provides information as requested in this document from and all liability or potential liability which may result from harm to me or my reputation as a direct or indirect of the furnishing such information. I further release the City of Titusville and its elected and appointed officials and its agents from any and all liability or potential liability relating to the seeking or obtaining of such information.
Name*

First NameMiddle NameLast Name
Signature*

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BACKGROUND INVESTIGATION RECORDS RELEASE

AUTHORIZATION AND RELEASE OF INFORMATION
I hereby authorize any federal, state, county, or local government agency, law enforcement agency, court, prosecutor’s office, school, employer (past or present), military organization, financial institution, credit bureau, licensing authority, medical provider (fitness-for-duty only), or any other person or organization to release any information regarding me to the Titusville Police Department for the purpose of conducting a pre-employment background investigation.

This authorization includes, but is not limited to, the release of:

• Criminal history records and investigative reports
• Incident reports, calls for service, or police contacts
• Employment records, disciplinary files, and performance history
• Driving records and traffic citations
• Educational and training records
• Military service records
• Financial/credit history (as permitted by law)
• Character references

I understand this information may be obtained in written, verbal, electronic, or recorded form.
Signature

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POLICE OFFICER JOB DESCRIPTION
Police Officer- Authority and Responsibilities: Every sworn member of the Titusville Police Department is a Police Officer, regardless of rank, position or specialized assignment (Patrol, Community Services, Traffic, etc.). Police Officers are responsible for performing a variety of duties related to the protection of life and property, enforcement of criminal and traffic laws, prevention of crime, preservation of the public peace, apprehension of criminals, and calls for service. They will perform these duties as prescribed in the department orders, standard operating procedures, directives, and as directed by their supervisors. In addition to these, and the general and individual responsibilities of all members and employees, Police Officers are responsible for the following:

1. Report promptly for duty at the designated time and place, in proper uniform for assignment and inspection. Listen attentively to orders and instructions from their supervisors and make written memoranda of such information as necessary and promptly report to their assignment upon completion.

2. Enforce all laws and ordinances for which the Department is responsible. Protect the lives and property of all persons; and maintain peace and order within the City of Titusville.

3. Develop and maintain a working knowledge of the relevant federal, state, and local laws, statutes and ordinances in order to ensure action in accordance with legal requirements.

4. Develop and maintain a working knowledge of judicial case law in the areas of search and seizure, arrest, self-incrimination, right to counsel, interrogation and confessions, and the collection and preservation of evidence in order to ensure action in accordance with current court decisions.

5. Operate a police vehicle for long periods of time within assigned geographic area at the direction of supervisor according to standard police techniques and strategies in order to deter and detect criminal activity.

6. Investigate the activities of suspicious persons as encountered or upon citizen complaint using standard police techniques and in conformance with the legal requirements in order to determine the identity, activity, and reason for the presence of the suspicious person.

7. Remain alert to the needs of citizens and take the appropriate action to maintain order and protect life and property.

8. Investigate all complaints on or near their area which are assigned to them or which are brought to their attention by citizens. Take suitable action in those cases which come under their jurisdiction or refer them to the proper authority.

9. Issue citations for violations of the Pennsylvania Vehicle Code and local ordinances as observed or determined in conformance with legal requirements and Department Policies and Procedures in order to ensure conformity with traffic laws and to prevent traffic accidents.

10. Direct vehicular traffic as required in order to ensure a safe, orderly flow of traffic.

11. Execute warrants or serve summonses in conformance with legal requirements and Department policies and procedures in order to comply with court orders. 323 N Franklin Street Titusville PA 16354 Phone: (814) 827-1890 Fax: 827-4219 City of Titusville Police Department “Birthplace of the Oil Industry”

12. Question suspects in accordance with legal requirements and Department policies and procedures using standard interrogation techniques and strategies in order to obtain information and/or a confession in reference to criminal activity.

13. Search individuals and their personal property after taking them into custody in compliance with legal requirements and Departmental policies and procedures using standard police search techniques to ensure the safety of the officer, other Department personnel, and the detainee.

14. Incarcerate arrested persons as required in accordance with legal requirements and Department policies and procedures using standard police techniques in order to detain arrested persons pending further investigation and/or processing through the criminal justice system.

15. Counsel juveniles and adults when deemed appropriate and refer them to the person or agencies where they can obtain further assistance.

16. Perform preliminary and follow-up investigations of criminal offenses which are assigned to them or brought to their attention and continue investigating such criminal offenses if assigned.

17. Assist any other officer in the preliminary or follow-up investigation of a case.

18. Appear on time, at all required court or any other required proceedings as a result of official police actions or activity. In addition, assist prosecuting attorneys in the preparation of court cases and when required, testify at all judicial or other proceedings.

19. Maintain a professional decorum and display a proper attitude in all dealings with citizens, supervisors and other department personnel.

20. Promptly and properly prepare and submit the required reports and documents as a result of any official assignment or investigation in a clear and concise manner.

21. Properly attend and successfully complete assigned training courses.

22. Make presentations and speeches to community organizations and groups, as assigned.

23. Assist in the securing of crime scenes and in the gathering and processing of evidence.

24. Maintain an open relationship with area law enforcement officers/agencies in order to exchange information and to facilitate cooperative efforts.

25. Pay strict adherence to all radio transmissions.

26. Utilize a community policing philosophy in problem solving when dealing with all aspects of assigned duties.

27. Be able to give credible testimony in a court of law or other proceeding.

28. Perform physical actions in order to apprehend and control suspects. To include: Running for several hundred yards, climbing over obstacles, crawling, pushing motor vehicles, pulling or carrying accident, fire or crime victims, and using physical force to apprehend and subdue arrestees.

29. Operate required equipment.

30. Use firearms effectively and qualify with required weapons and other equipment or devices.

31. Obtain, read, and have a working knowledge of all relevant Department directives.

32. Provide residents and businesses with a highly visible and proactive police presence by patrolling on foot, bicycle, or motor vehicle.

33. Identify on-going problems, conduct follow-ups, and implement corrective measures.

34. Arrest and prosecution of adult and juvenile criminal offenders.

35. Gather intelligence information and forward this information to the proper personnel or agency.

36. Familiarize themselves with the residents and businesses within their area of patrol. This shall be accomplished by personal contact while on patrol as well as attending regularly scheduled community meetings and events when required.

37. Work with the various social agencies and schools that serve the community.

38. Respond to calls for service within their assigned areas or any other area within the city as directed.

39. Conduct runaway investigations when assigned.

40. Liaison with Federal, State, County, and other local police and Human Service Agencies.

41. Provide any service that is necessary for the furtherance of the Department's mission and objectives.

42. Withstanding frequent exposure to stress-producing situations such as encountering persons injured or killed by accidents, crimes, or suicide.

43. I have reviewed the above list of essential job functions for a City of Titusville police officer and believe that:
I can fully perform all duties with or without reasonable accommodations*
Signature*

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FILE UPLOAD

Please upload a copy of your driver's license, high school/college diplomas (or transcripts), military separation (DD-214), police academy diploma, etc.
Driver's License*

Browse Files

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High School Diploma/GED*

Browse Files

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College/University Degree/Diploma

Browse Files

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Police Academy Certification

Browse Files

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Military DD-214

Browse Files

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High School/College Transcript

Browse Files

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SUBMISSION

Thank you for your interest in the City of Titusville Police Department. Commissioner LeGoullon will be in touch with you within 48 hours of submission of this application.
I certify that there are no misrepresentations, omissions, or falsifications in the foregoing statements and answers, and that the entries made by me above are true, complete, and correct to the best of my knowledge and belief and are made in good faith.
Signature*

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CITY OF TITUSVILLE POLICE DEPARTMENT

RESIDENCES

FAMILY

CRIMINAL RECORD AND FINANCIAL STATUS

PAST AND PRESENT MEMBERSHIP AND ORGANIZATIONS AND SUBVERSIVE ORGANIZATIONS

EDUCATION

EMPLOYMENT

CHARACTER REFERENCE

MILITARY STATUS

NOTIFICATION PROCEDURE RELEASE

VERIFICATION AND APPLICANT BACKGROUND WAIVER

CONSENT TO OBTAIN CONSUMER REPORT

AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION

REFERENCE CHECKS

BACKGROUND INVESTIGATION RECORDS RELEASE

POLICE OFFICER JOB DESCRIPTION

FILE UPLOAD

SUBMISSION