• Employment Application for Lateral Transfer Applicants to the Pekin Police Department

  • Your application will be considered with others without regard to race, color, religion, sex, national origin, age, ancestry, handicap, disability or other legally protected status, in accordance with all applicable legal requirements. All information contained in or connected with the application will be considered personal and confidential and used only in conjunction with your possible employment. 

  • Application Date:*
     - -
  • Date of Birth:*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Are you a United States citizen?*
  • Are you currently a law enforcement officer?*

  • LEGAL

  • Have you ever been charged and/or convicted of any criminal charge whether felony or misdemeanor:*
  • How did you learn of this employment opportunity?*

  • EMPLOYMENT HISTORY

    Begin with your present or most recent employer and continue in reverse order.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Dates Employed:*
     - -
  • *
     - -
  • Employment Type:*
  • Did you supervise others?*
    • Second Most Recent Employer: 
    • Format: (000) 000-0000.
    • Format: (000) 000-0000.
    • Dates Employed:
       - -
    •  - -
    • Employment Type:
    • Did you supervise others?
    • Third Most Recent Employer: 
    • Format: (000) 000-0000.
    • Format: (000) 000-0000.
    • Dates Employed:
       - -
    •  - -
    • Employment Type:
    • Did you supervise others?

  • EDUCATION RECORD

  • LIST ALL COLLEGES OR UNIVERSITIES ATTENDED:

  • LIST ALL TRADE, BUSINESS, TECHNICAL, OR MILITARY SCHOOLS ATTENDED:

  • DRIVING RECORD

  • Exp. Date:*
     - -

  • PROVIDE DETAILS REGARDING ANY ACCIDENTS, TRAFFIC CONVICTIONS, OR LICENSE FORFEITURES IN THE LAST 3 YEARS:

  • Has driver's license ever been denied, suspended or revoked?*

  • READ CAREFULLY BEFORE SIGNING THIS STATEMENT

    I certify that the information given on this application and on any appended materials is true and complete to the best of my knowledge. I understand that any false or misleading information and/or omissions may result in the rejection of my application or, if employed, in termination of employment. 

    To determine my qualifications for employment, I authorize the City of Pekin to review my previous employment, driving, and criminal records and/or other background data as it may relate to the position for which I am applying. I hereby authorize all former employers and educational institutions to furnish any and all information they may have and release all parties from liability for any damage that may result from furnishing such information. 

    In consideration for employment, I agree to conform to the rules and regulations of the City of Pekin. I understand that no one other than the City Manager or Human Resources Director has the authority to enter into any agreement or contract for employment. 

    I understand that I will be required to undergo a post-offer medical exam that includes a drug screen, and I will be required to undergo a polygraph examination and psychological examination. If I should fail an examination for any reason, my offer of employment may be withdrawn. 

  • Date:*
     - -

  • PHYSICAL AGILITY TEST - RELEASE OF ALL LIABILITIES

  • THE UNDERSIGNED, RECOGNIZING THAT THE PHYSICAL AGILITY TEST IS AN INTEGRAL PART OF THE EXAMINATION FOR FIRE FIGHTERS OR POLICE OFFICERS IN THE CITY OF PEKIN, ILLINOIS, HEREBY RELEASES, REMISES AND DISCHARGES THE CITY OF PEKIN, A MUNICIPAL CORPORATION, THE BOARD OF FIRE AND POLICE COMMISSIONERS OF THE CITY OF PEKIN, THE TESTING AGENCY CONTRACTED TO DO THE TEST(S) SHOULD IT BE CONTRACTED OUT, THEIR OFFICERS, SERVANTS, AGENTS AND EMPLOYEES OF AND FROM ANY AND ALL INJURIES, LOSSES AND DAMAGES TO MY PERSON SHALL HAVE CAUSED, OR MAY AT ANY TIME ARISE AS THE RESULT OF CERTAIN FIRE OR POLICE EXAMINATIONS CONDUCTED BY THE BOARD OF FIRE AND POLICE COMMISSIONERS OF SAID PEKIN, ILLINOIS. THE INTENTION HEREOF BEING TO COMPLETELY, ABSOLUTELY AND FINALLY RELEASE SAID CITY OF PEKIN, ILLINOIS, THE BOARD OF FIRE AND POLICE COMMISSIONERS, THE TESTING AGENCY CONTRACTED TO DO THE TEST(S) THEIR OFFICERS, SERVANTS, AGENTS AND EMPLOYEES OF AND FROM ANY AND ALL LIABILITY ARISING WHOLLY OR PARTIALLY FROM THE CAUSE AFORESAID. 

  • Date:*
     - -

  • I, THE UNDERSIGNED, UNDERSTAND THAT ALL OF THE TESTS AND THE RESULTS THEREOF BECOME THE PROPERTY OF THE BOARD OF FIRE AND POLICE COMMISSIONERS OF THE CITY OF PEKIN AND ARE NOT SUBJECT TO REVIEW. 

  • Date:*
     - -

  • BEFORE SUBMITTING:

    Please attach proof of Certification as a Full-time
    Certified Law Enforcement Officer

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