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Police Application for Employment
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Steps
1.
Application
This section is complete
This section is incomplete
2.
Experience
This section is complete
This section is incomplete
3.
Education
This section is complete
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Application
The City of Piedmont does not discriminate on the basis of race, religion, color, sex, national origin, age, marital or veteran's status, and political affiliation, disabled status, or any other legally protected status.
The Piedmont Police Department, after reviewing your application form, verifying your responses, and conducting necessary interviews or test, you are considered for the job and would need reasonable accommodation to perform the essential job functions, the parties will explore these alternatives. Remember, the Police Department conducts a pre-employment exam, which will determine whether you can do the essential functions of the job without substantial risk to yourself and the public.
In addition, please provide us with prior education, work experience, and relevant training or certificates and licenses that would indicate your knowledge, skills, CLEET Training if any and abilities to perform the job duties. Be as specific as possible since you will be screened on what you include, regardless of what you might otherwise be able to perform.
Print or type answers to each question clearly and completely. All questions must be answered. This is an application for employment and no employment contract is being offered. The City of Piedmont may change wages, benefits, and conditions of employment at anytime. If you need assistance in completing this application form, or in participating in the selection process, please inform the Chief of Police.
Position Applying For
*
Last Name
*
First Name
*
Middle Name
*
Address
*
City
*
State
*
Zip
*
Home Phone
*
Work Phone
*
Have you ever worked for the City of Piedmont?
*
Yes
No
Give dates / reason for leaving:
Are you prevented from lawfully becoming employed in the Country because of Visa and/or Immigration status?
*
Yes
No
Proof of Citizenship may be required upon employment.
Date available for work:
*
Date available for work:
Work Availability
*
Full Time
Nights
Part Time
Shifts
Weekends
Do you have a current Oklahoma State Drivers License?
*
Yes
No
Continue
Experience
Military Service
Branch of Service
Date Entered
Date Entered
Date and type of discharge:
List any specific military experience or training that is job-related:
References
1 - Reference Name
*
Phone
*
Address
*
2 - Reference Name
*
Phone
*
Address
*
3 - Reference Name
*
Phone
*
Address
*
Employment Experience
1 - Employer
*
Phone
*
Address
*
Job Title
*
Supervisor
*
Dates of Employment
Dates of Employment Start Date
—
Dates of Employment End Date
Salary
*
Reason for Leaving
*
2 - Employer
*
Phone
*
Address
*
Job Title
*
Supervisor
*
Dates of Employment
*
Dates of Employment Start Date
—
Dates of Employment End Date
Salary
*
Reason for Leaving
*
3 - Employer
*
Phone
*
Address
*
Job Title
*
Supervisor
*
Dates of Employment
Dates of Employment Start Date
—
Dates of Employment End Date
Salary
*
Reason for Leaving
*
Are you related to any city employee or any member of the city council?
*
Yes
No
Give name, department, relationship:
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Education
Elementary School
*
Provide name of school, course of study, years completed, diploma, and number of hours.
High School
*
Provide name of school, course of study, years completed, diploma, and number of hours.
College
Provide name of school, course of study, years completed, diploma, and number of hours.
Other
Please specify.
Special Training / Licenses
Describe any specialized training or special license which would help us determine your suitability for this position. All attachments must be signed.
Test for Safe Participation
Test for Safe Participation (PDF)
Release of Information
Release of Information Authorization (PDF)
Signature
*
I certify that the facts given in this application are true and complete to the best of my knowledge. I hereby grant permission to the City of Piedmont's Police Department to investigate any information included in this application and I agree to medical examination if required. I understand that this application is not a contract of employment. I live hereby release the City of Piedmont and it's agents from all liability in making any investigation and inquiry relative to information contained in the application form. I understand that if employed, false information or misleading statements given in this application or interview(s) may result in discharge. I understand that I am required to abide by all rules and regulation of the City of Piedmont's Police Department.
I agree.
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