Police Department Employment Application

Notice: All questions must be answered, if applicable. If not, indicate NA (not applicable.) Applications which are incomplete will not be considered.
Date*
Date Format: MM slash DD slash YYYY
Please choose the position for which you are applying:
- Police Officer
- Police Reserve Officer
- Dispatcher/Clerk
Application Information
Name
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone
Work Phone
Mobile Phone
Applicant Email*
Social Security #*
Have you successfully completed the basic training required for certification (i.e. 520-hour law enforcement academy)?
- Yes
- No
Are you age 18 or over?
- Yes
- No
Are you a United States citizen?
- Yes
- No
Do you possess a valid Driver’s License?
- Yes
- No
Driver's License Number
Do you have a high school diploma, GED or HSED?
- Yes
- No
Do you have an Associate Degree or 60 associate degree level credits or higher from an accredited college or university?
- Yes
- No
If No, were you employed as a law enforcement officer prior to February 1, 1993?
- Yes
- No
The college credit requirement as written in Wisconsin Administrative Code § LES 2.01 (1 )(e), pertains to law enforcement and tribal law enforcement officers first employed on or after February 1, 1993.
Have you ever been convicted of a felony?
- Yes
- No
Have you ever been convicted of a misdemeanor crime of domestic violence?
- Yes
- No
Are you prohibited by state or federal law from possessing a firearm?
- Yes
- No
Please Note: A conviction record or a pending criminal charge will not automatically bar you from employment and will only be considered as it relates to the particular job in question.
Education
Name and Location of High School
Highest Grade or Year Completed
Highest Grade or Year Completed
Post High School Education—Technical School/College/University or Other
Name and Location
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Minor/Major
Degree
GPA
Graduate?
- Yes
- No
Name and Location
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Minor/Major
Degree
GPA
Graduate?
- Yes
- No
Name and Location
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Minor/Major
Degree
GPA
Graduate?
- Yes
- No
Name and Location
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Minor/Major
Degree
GPA
Graduate?
- Yes
- No
Name and Location
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Minor/Major
Degree
GPA
Graduate?
- Yes
- No
Employment History
Begin with current or most recent position and continue with all past employment. Attach additional sheet if necessary.
Employer Name
Address
Street Address Address Line 2 City State ZIP Code
Position(s) Held
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Responsibilities
Supervisor
First Last
Supervisor Phone Number
Starting Salary
Ending Salary
Reason for Leaving
May we contact this employer for a reference?
- Yes
- No
Employer Name
Address
Street Address Address Line 2 City State ZIP Code
Position(s) Held
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Responsibilities
Supervisor
First Last
Supervisor Phone Number
Starting Salary
Ending Salary
Reason for Leaving
May we contact this employer for a reference?
- Yes
- No
Employer Name
Address
Street Address Address Line 2 City State ZIP Code
Position(s) Held
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Responsibilities
Supervisor
First Last
Supervisor Phone Number
Starting Salary
Ending Salary
Reason for Leaving
May we contact this employer for a reference?
- Yes
- No
Employer Name
Address
Street Address Address Line 2 City State ZIP Code
Position(s) Held
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Responsibilities
Supervisor
First Last
Supervisor Phone Number
Starting Salary
Ending Salary
Reason for Leaving
May we contact this employer for a reference?
- Yes
- No
Military Service
Branch of Service
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Active Duty or Reserve
- Active Duty
- Reserve
Highest Grade
Skill Specialty or Primary Duty
Branch of Service
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Active Duty or Reserve
- Active Duty
- Reserve
Highest Grade
Skill Specialty or Primary Duty
Branch of Service
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Active Duty or Reserve
- Active Duty
- Reserve
Highest Grade
Skill Specialty or Primary Duty
Honorably Discharged from Military Service?
- Yes
- No
- Not applicable
Personal References
Give three references (not relatives, or present employer; avoid listing members of the clergy).
Name
First Last
Phone
Occupation
Email
Years Known
Name
First Last
Phone
Occupation
Email
Years Known
Name
First Last
Phone
Occupation
Email
Years Known
General Information
COMPLETE IF INSTRUCTED TO DO SO BY EMPLOYING AGENCY.
Attach no more than one additional page for each answer.
Why have you chosen to apply for this position?
Discuss things you have done which have contributed to your life experience. Be sure to include information regarding volunteer work with civic, school, or professional organizations. Be specific about names and dates.
Why do you believe you could relate to and/or work with people of different races, genders, cultures, ages, socio-economic groups, and educational levels?
Applicant Please Read Carefully and Sign Below
Information provided and statements made as part of this application may be grounds for not employing you or for dismissing you after you begin work. All information and statements made are subject to verification.

CERTIFICATION

ALL INFORMATION PROVIDED AND STATEMENTS MADE BY ME AS PART OF THIS APPLICATION, OR AS PART OF ANY ADDITIONAL INFORMATION PROVIDED IN SUPPORT OF THIS APPLICATION, ARE COMPLETE, CORRECT, AND TRUE TO THE BEST OF MY KNOWLEDGE.

I UNDERSTAND THAT IF I AM EMPLOYED, FALSE INFORMATION PROVIDED OR FALSE STATEMENTS MADE AS PART OF THIS APPLICATION MAY BE CONSIDERED AS CAUSE FOR DISMISSAL.
Signature
Under the provisions of§ 19.36, Wis. Stats., I request that my identity as an applicant for this position not be revealed without my consent or until required under law.
Date
Date Format: MM slash DD slash YYYY

Police Department Employment Application

Application Information

Education

Post High School Education—Technical School/College/University or Other

Employment History

Military Service

Personal References

General Information

Applicant Please Read Carefully and Sign Below