Kenova Police Department

Kenova Police Department

Employment Application
APPLICANT INFORMATION
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Date Available

MonthDayYear
Date
Desired Salary
Position Applied For
YesNo
YesNo
YesNo
If "Yes" when?
YesNo
If "Yes" explain.
EDUCATION
High School
High School Address
Years attended
YesNo
College
Years attended
YesNo
Your Degree
Other Education
Years attended
YesNo
Your Degree
Previous Employment
Company
Phone Number

Area CodePhone Number
Address
Supervisor
Job Title
Salary
Date Started

MonthDayYear
Date
Date Left

MonthDayYear
Date
Reason for leaving
YesNo
Company
Phone Number

Area CodePhone Number
Address
Supervisor
Job Title
Salary
Date Started

MonthDayYear
Date
Date Left

MonthDayYear
Date
Reason for leaving
YesNo
Company
Phone Number

Area CodePhone Number
Address
Supervisor
Job Title
Salary
Date Started

MonthDayYear
Date
Date Left

MonthDayYear
Date
Reason for leaving
YesNo
Military Service
Brancy
Start Date

MonthDayYear
Date
Discharge Date

MonthDayYear
Date
Rank at Discharge
Type of Discharge
If other than Honorable, explain.
Special Skills and Training
Special skills, training, certifications, etc.
When is the best time to contact you?*

:HourMinutesAM/PM Option
YesNo
State Issued*
NoYes
What date can you start?*

MonthDayYear
Date
Desired Pay*
NoYes
NoYes
NoYes
NoYes
Additional Comments
Disclaimer and Signature

I certify that my answers are true and complete.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my termination.

I understand that my failure to successfully complete treaining or to achieve required certifications may be grounds for my termination.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: