Police officer job application

Military service record
Have you ever served in the U.S. Armed Forces?*

YesNo
If yes, what branch?*
Date of service (start)*

MonthDayYear
Date
Date of service (end)*

MonthDayYear
Date
Rank*
Upload a copy of your military service record*

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Type of discharge*
Upload a copy of your military discharge papers*

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Education, training and experience
High school*
Upload a copy of your high school diploma or G.E.D. certificate*

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College
Upload a copy of your college or university diploma with transcript if attained

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College
Upload a copy of your college or university diploma with transcript if attained

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College
Upload a copy of your college or university diploma with transcript if attained

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Other training and experience
Add more training and experience?

YesNo
Other training and experience

Work references

List 2
Name (work reference #1)*

First NameLast Name
Address (work reference #1)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (work reference #1)*
Please enter a valid phone number.
Name (work reference #2)*

First NameLast Name
Address (work reference #2)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (work reference #2)*
Please enter a valid phone number.
Personal references

List 2
Name (personal reference #1)*

First NameLast Name
Address (personal reference #1)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (personal reference #1)*
Please enter a valid phone number.
Name (personal reference #2)*

First NameLast Name
Address (personal reference #2)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (personal reference #2)*
Please enter a valid phone number.

Qualifications for Police Officer Applicants

Sign this form to confirm you meet the qualifications.
- Age. Applicants shall be under 35 years of age, at the time of application and at such time as the final eligibility list is posted, unless exempt from such age limitation as provided in Sections 5/10-2.1-6 or 5/10-2.1-6.3 (c) of the Fire and Police Commissioner's Act. Applicants, at such time as they file their application with this Board, must be 21 years of age, provided, however, that applicants for initial appointment as a full-time police officer who are 20 years of age and who have successfully completed two (2) years of law enforcement studies at an accredited college or university may be considered for appointment to active duty with the Police Department, as provided in Section 5/10-2.1-6 of the Fire and Police Commissioner's Act. Proof of birth date will be required at time of application.
- Physical Ability Test. All applicants for a position with the police department shall possess a valid Peace Officer Wellness Evaluation Report (POWER) Certificate issued by a qualified testing facility no more than 365 days prior to the date scheduled for the written exam. The applicant shall obtain the POWER certificate at his or her own expense.
- Education. Applicants must have a high school diploma or a General Equivalency Diploma (GED).
- Citizenship. Applicants for examination must be citizens of the United States and/or an alien admitted for permanent residence or lawfully admitted for temporary residence and who produces evidence of intention to become a citizen of the United States.
- Criminal record. Applicants may have no felony convictions or no misdemeanor convictions involving moral turpitude, as specified in the Board of Fire and Police Commissioners Act.
- Drug use. Applicants must not be addicted to the use of drugs or intoxicating beverages or must not be found to have taken or used drugs and/or narcotics illegally.
- Good driving and employment record. Applicants must possess a valid driver's license and have a good driving and employment record.
- Background investigation.
1. Verification of qualifying credentials
2. A review of any criminal record
3. Verification of at least three personal references
I, First Name* Last Name* , do hereby acknowledge that I have read and understand the qualifications set forth by the Board of Fire & Police Commissioners for all Police applicants. By my signature below, I agree that I meet all of these qualifications.
Signature*

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Date (today)*

MonthDayYear
Date

Consumer report authorization/disclosure

Sign this form to authorize us to verify your background.
In connection with my application for employment as a police officer for the City of Effingham, Illinois, I understand that the City will obtain consumer reports and/or investigative reports concerning my consumer credit, criminal background, driving history, prior employment verifications, educational experience/records, personal background/history, and other information about my past. Investigation of my prior credit history, educational, personal and work-related background will be obtained through personal interviews as well as through requests for information from various federal, state, and local govemrnental agencies, which will be provided with a copy of this authorization form signed by you.

By signing below, you are authorizing the City of Effingham and/or its designated representatives to retrieve all information described above and to use such information in its determining whether you will be considered to be eligible for employment as a police officer with the City of Effingham, Illinois.

By signing below, I do hereby forever discharge the City of Effingham, its agents and its representatives and employees to the full extent permitted by the law from damages, losses, liabilities, costs and expenses, or other charge of complaint filed with any agency arising from the retrieving and reporting of information according to the Federal Fair Credit Reporting Act, I am entitled to know if adverse action is taken based on information obtained by the City of Effingham and to receive, orally, written or electronically, a copy of the report and a description of the rights of a consumer.

I hereby certify that all of the statements and answers set forth in the application form and/or my resume are true and complete to the best of my knowledge, and I understand that if subsequent to employment any such statements and/or answers are found false or that information has been omitted, such false statements or omissions will result in the termination of my employment.
List any other cities and states where you have lived or worked in the previous 7 years
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In the event that information from the reports described above is utilized in whole or in part in making an adverse decision with regard to your potential employment, before making the adverse decision, we will provide you with a copy of the consumer report and a description in writing of your rights under the federal Fair Credit Reporting Act. The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. You will be given a summary of these rights in dealing with consumer reporting agencies.

By your signature below, you hereby authorize us to obtain the information and reports described above in order to consider you for employment. Your signature also acknowledges that the City of Effingham has made this disclosure and authorizes the City to complete such verification.

NOTE: The information below is provided voluntarily and is not considered part of your application for employment. It is used for identification purposes in verifying criminal background verifications as required by appropriate legislation and authorizes the City to do so. Furthermore, this document serves solely as a clear and conspicuous written disclosure to the applicant that a background check including consumer credit report may be obtained for the purpose of this employment application only.
Applicant's name*

First NameLast Name
Applicant's address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social security number*
The undersigned certifies that he/she has read the entire contents of the foregoing, fully understands all statements contained herein, and is voluntarily executing this
Authorization/Disclosure form with full knowledge of its meaning and significance.
Signature*

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Date (today)*

MonthDayYear
Date

Receipt reimbursement agreement

Notice to applicants for employment as an officer with the City of Effingham Police Department of policy concerning reimbursement of hiring, training, and uniform expenses.
Chapter II - Section 8 of the Rules and Regulations of the Board and Fire and Police
Commissioners for the City of Effingham, Illinois requires that all individuals tendered an offer for employment as an officer of the City of Effingham Fire Department or Effingham Police Department, as a condition of employment, shall execute and deliver to the Board a reimbursement agreement for hiring, training, and uniform expenses, on a form to be prescribed by the Board.
Receipt

The undersigned, First Name* Last Name* , by execution hereof acknowledges receipt of the above said notice this day of Date*
Applicant signature*

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POWER (Peace Officer Wellness Evaluation Report) certificate
If you have a valid Illinois POWER test card, you are not required to participate in physical fitness testing.

If you do not have a valid POWER test card, you are required to complete and successfully pass the Illinois POWER test during the testing process.
Upload a copy of your POWER certificate

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Consent and signature
Date (today)*

MonthDayYear
Date
Signature*

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Police officer job application

Personal information

Employment history

Military service record

Education, training and experience

Work references

Personal references

Qualifications for Police Officer Applicants

Consumer report authorization/disclosure

Receipt reimbursement agreement

POWER (Peace Officer Wellness Evaluation Report) certificate

Consent and signature