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Zionsville Police Application Form

  1. Zionsville Public Safety Indiana Crest Established 1852

  2. Application

  3. Instructions

  4. 1) Answer all questions. If the question does not apply to you, mark the question “NA”.

  5. 2) After completion print application.

  6. 3) Sign in the presence of a licensed Notary Public.

  7. 4) Submit in person or mail. No faxed or E-mailed applications will be accepted.

  8. Any further information you may wish to add may be placed on the last page of the application with the reference to the question you are expanding on. Applications will not be considered until complete in every aspect. Any false information provided on the application or information omissions will disqualify the candidate from the employment screening process. Any false or omitted application information will be cause for immediate disqualification. Completed applications will be kept for one full year from the date of employment screening process. Please do not make inquiry regarding the status of your application. You will receive appropriate information regarding your screening process in due time.

  9. How did you hear about this opening?*

  10. Minimum Requirements for Zionsville Police Officer Applicants:

  11. 1. Must be a high school graduate or equivalent.

  12. 2. Shall possess an Indiana Driver's License or have the ability to obtain one if a conditional offer is extended.

  13. 3. Shall be a U.S. Citizen.

  14. 4. Shall be at least 21 years of age, and for full time status, must not have reached age 36 by date of hire if not already enrolled in the PERF 77 pension. Applicatns with twenty years of credible military experence have the maximum age waived to forty years and six months.

  15. 5. If offered a position, candidate must obtain residence within a contiguous county to Boone County, Indiana.within 180 days.

  16. Applicants are responsible for all expenses incurred for travel, meals, etc. when reporting for tests and interviews; as well as all expenses incurred in obtaining records or other materials necessary for the investigative process. Upon return of the application, the following documents are REQUIRED:

  17. 1. Birth Certificate (certified copy)

  18. 2. High School Diploma or equivalent and transcripts.

  19. 3. College or University Degree Transcript (If Applicable)

  20. 4. DD214 (member 4 copy) and Citations (for those applicants with military background).

  21. 5. Law Enforcement Academy Graduation Certificate (If Applicable)

  22. 6. Copy of Driver's License (Front and Back)

  23. 7. Copy of Social Security Card.

  24. 8. Any Court Order requesting a name change (If Applicable)

  25. These copies become the property of the Zionsville Police Department and are not subject to return. After an offer of employment, the candidate will be required to undergo a physical and psychological examination by a Department appointed physician. The candidate must also pass a polygraph exam and full time/non-lateral candidates must pass a physical agility test per the ILEA exit standard. The Zionsville Police Department will pay for the above testing.

  26. I UNDERSTAND AND AGREE TO ALL OF THE ABOVE TERMS AND INFORMATION

  27. Upon completing the application be sure to print and sign below before submission.

  28. GENERAL INFORMATION:

  29. Are you eligible to work in the United States? (Check)*

  30. Can you with or without reasonable accommodation perform the essential functions of this job (Check)*

  31. Have you ever applied for a position with the Town of Zionsville? (Check)*

  32. Have you ever worked for the Town of Zionsville? (Check)*

  33. Is anyone related to you employed by the Town of Zionsville? (Check)*

  34. EMPLOYMENT HISTORY:

  35. Current Employer

  36. Prior Employment #1

  37. Prior Employment #2

  38. Prior Employment #3

  39. Prior Employment #4

  40. Prior Employment #5

  41. Prior Employment #6

  42. Have you ever been asked to resign or discharged by an empoyer?*

  43. If yes, please attach an explanation on another sheet of paper.

  44. Do you currently have an application pending with any other law enforcement agency?*

  45. If Yes, List:

  46. Have you ever applied for a position of employment with any other law enforcement agency?

  47. If Yes List:

  48. EDUCATION AND SKILLS:

  49. Please include copies of all transcripts and diplomas

  50. Did You Graduate?

  51. Did You Graduate?

  52. Did You Graduate?

  53. Criminal Justice Education / Training: Include certificates of basic compliance:

  54. Did You Graduate (check)

  55. Other Schools (Trade, Vocational, Business, or Military):

  56. Did You Graduate (check)

  57. List languages other than English (including sign language) and indicate your knowledge in each area by rating from 1-5 (5 rated as fluent)

  58. Reading

  59. Writing

  60. Speaking

  61. Understanding

  62. Reading

  63. Writing

  64. Speaking

  65. Understanding

  66. Reading

  67. Writing

  68. Speaking

  69. Understanding

  70. Reading

  71. Writing

  72. Speaking

  73. Understanding

  74. PAST RESIDENCES:

  75. If rental, list name, address and phone number of landlord and name of apartment complex (if applicable). if military addresses are listed, include town / city located in the immediate vicinity of the military base.

  76. Current Residence

  77. Former Addresses - Last ten years (include Dates and Addresses):

  78. PERSONAL HISTORY:

  79. Family Data - List all family members (living or deceased) in the following order: Parents; Step-parents; brothers; sisters; spouse; children; step-children;parents-in-law; ex-spouse

  80. REFERENCES:

  81. Neighbor References (List three (3) in the last three (3) years):

  82. Character References (Minimum of three - not family-related):

  83. Work Related References (minimum of three):

  84. MILITARY HISTORY:

  85. 1. Have you ever served in the Armed Forces for the United States of America? (Check)

  86. 2. Are you now or have you ever been a member of a U.S. reserve unit or the National Guard? (Check

  87. 3. If you served in the Armed forces, you must provide copies of all DD214s

  88. 6. Was any type of disciplinary action taken against you in the service? Includes, but not limited to, a letter of reprimand, forfeiture of pay or demotion? (circle)

  89. If Yes, Please Provide:

  90. ARREST HISTORY:

  91. 1. Have you ever committed a crime that would be considered a misdemeanor or felony,for which you were not arrested or convicted? (check)

  92. 2. Have you ever been charged (plead guilty, nolo contender) of a crime other than a traffic violation? (Include Juvenile Arrests)

  93. If Yes, Provide the Following:

  94. 3. Have you ever been charged, investigated, arrested or convicted of Domestic Violence? (Check)

  95. If Yes, Provide the Following:

  96. 4. Have you ever been detained by any law enforcement agency for any reason? (check)

  97. 5. To the best of your knowledge, have you ever been the subject of, or a suspect in, any criminal investigation? (check)

  98. 6. Have you ever been fingerprinted for any reason? (arrest, job application, military, etc.) (Check

  99. 7. Have you ever been placed on probation? (check)

  100. DRIVING HISTORY:

  101. Have you ever been denied issuance of a driver's license or have you ever had a driver's license suspended or revoked? (Check)

  102. Do you presently have automobile liability insurance in accordance with Indiana State Statutes? (Check)

  103. Have you ever received a ticket or been convicted of a traffic violation (Exclude parking tickets)? Check)

  104. Have you ever had automobile insurance withdrawn or revoked or have you ever been refused automobile insurance? (Check)

  105. Were any accidents job related? (Check)

  106. Did any accidents result in disciplinary action? (Check)

  107. MISCELLANEOUS:

  108. 1. Are you now or have you ever been issued a license to engage in a business or profession? (Check)

  109. 2. Was your business or occupational license ever cancelled, suspended or revoked? (Check)

  110. 3. Do you have any sources of income other than your salary or the salary of your spouse? (Check)

  111. 4. Do you now, or have you ever used, purchased, possessed, supplied or sold marijuana or hashish? (Check)

  112. If Yes, List the Following:

  113. 5. Do you now, or have you ever used, purchased, possessed, supplied, and / or sold any narcotic or controlled substance such as, but not limited to, cocaine, LSD, amphetamines, heroin, steroid, or any drug of similar nature? (Check)

  114. If Yes, List the Following:

  115. 8. Are you a U.S. Citizen? (Check)

  116. Authorization for Release of Information Agreement:

  117. *PLEASE READ CAREFULLY BEFORE SIGNING* I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery. I have reviewed the direct line of supervision for the position I am seeking with the Town of Zionsville and am not a relative of any employee who will be in my direct line of supervision. I understand that relative means my spouse, parent or stepparent, child or stepchild, brother, sister, stepbrother, stepsister, niece, nephew, aunt, uncle, daughter - or son-in-law (including half-bloods and adopted children). I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by The Town of Zionsville ( hereafter referred to as The Town) that such employment with The Town is at will, for no specified duration and may be terminated by either The Town or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of The Town or its representatives used during the employment process is deemed a contract of employment real or implied. I understand that no representative of The Town except the President of the Town Council has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the President of the Town Council. In consideration for employment with The Town, if employed, I agree to conform to the rules, regulations, policies and procedures of The Town at all times and understand that such obedience is a condition of employment. I understand that due to the nature of The Town business, attendance and punctuality are considered essential requirements of every job at The Town and that poor attendance or tardiness will result in disciplinary action. I understand that if offered a position with The Town, I may be required to submint medical examination, drug screening and background check as a condition of employment. I understand unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employments tests and checks will result in withdrawal of any employment offer or termination of employment if already employed. I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to The Town and/or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information. BY SIGNING BELOW I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS.

  118. SIGNATURE MUST BE NOTORIZED

  119. Signature______________________________________________

  120. Date:__________________

  121. Before me, a Notary Public in and for Said County and State, personally appeared __________________________ who acknowledged the execution of the foregoing Authorization for Release of Information Agreement, and who being first sworn under oath that the matters contained therein are true. Subscribed and sworn before me.

  122. WITNESS my hand and Notarial Seal this the ____________ day of ______________, 20____ Notary Public Printed Name: __________________________________________ Notary Signature: _________________________________________________ City: ______________________________ State: _______ / County: _______________________________________ My Commission Expires: ________________________________________________

  123. THE TOWN OF ZIONSVILLE IS PROUD TO BE AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, DISABILITY, GENETIC INFORMATION, HANDICAP, VETERAN STATUS OR ANY OTHER STATUS PROTECTED BY LAW.

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