PERSONAL INFORMATION
Today's Date(DD/MM/YYYY):
Last Name:
First Name:
Middle Name(s):
Date of Birth(DD/MM/YYYY):
Present Address:
Phone Number(s):
Sex (optional):
Race (optional):
Height:
Weight:
Education:
Current Employment:
Birthplace:
Nationality:
Driver's license:
Previous comitted cimes:
Current physical, medical and mental condition:
Law enforcement experience:
Reason of becoming a State Police Department employee:
APPLICANT'S STATEMENT
I certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct. I further certify that I, the undersigned applicant, have personally compvleted this application. I understand that any omission or misstatement on this application or on any documents used to secure employment may be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I authorize the State Police Department to thoroughly investigate my work records, education and other matters related to my suitability for employment and to contact my current and previous employers. I fully understand that the State Police Department conducts a background investigation of all applicants. This investigation includes, but is not limited to, an investigation of my past employment performance, school records, military, police driving records and character traits. I authorize any person, school, current and former employers, law enforcement authorities, and organizations named in the application and this supplemental application to provide and release any information and opinions concerning my background, without giving me prior notice of such disclosure. I release such persons and organizations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
I understand and agree that if I am employed, my employment relationship with the State Police Department is strictly voluntary and at our mutual will. I understand that if employed, my employment is for no definite period and may be terminated at any time, with or without prior notice, with or without cause or reason, at the option of either myself or the State Police Department, and that no promises or representations contrary to the forgoing are binding on the State Police Department unless made in writing and signed jointly by the Chief Sergeant of the department and myself.
My signature below certifies that I have read and understand the instructions, conditions and other information provided in this document and that I hereby authorize release of all above listed records to the State Police Department.
Signature:
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