Pulaski Police Department Employment Application

  Application for Employment with the Pulaski Police Department

  Personal Information

NAME (LAST NAME FIRST)

 

PHYSICAL ADDRESS

      

CITY

      

STATE

    

ZIP CODE

      

PERMANENT ADDRESS

      

CITY

      

STATE

    

ZIP CODE

      

E-MAIL ADDRESS

      

 

 

PHONE NUMBER

     

 

SECONDARY PHONE NUMBER

     

 

REFERRED BY

 

      

 

 

 

  Employment Desired

POSITION

DATE YOU CAN START

 

ARE YOU EMPLOYED NOW?


 Yes  No

IF SO, MAY WE INQUIRE OF YOUR PRESENT EMPLOYER?

 

Yes  No

ARE YOU LEGALLY AUTHORIZED TO WORK IN THE U.S.?

 

Yes  No

EVER APPLIED TO THE TOWN OF PULASKI BEFORE?

Yes  No

WHERE

WHEN

EVER WORKED FOR THE TOWN OF PULASKI BEFORE?

Yes  No

WHERE

WHEN

REASON FOR LEAVING

NAME OF LAST SUPERVISOR AT THIS COMPANY

HOW DID YOU FIND OUT ABOUT THIS POSITION?

 

 

 

 

 

 

  Education History

 

NAME & LOCATION OF SCHOOL

YEARS ATTENDED

DID YOU GRADUATE?

SUBJECTS STUDIED

HIGH SCHOOL

Yes  No

COLLEGE

Yes  No

TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL

Yes  No

 

 

  General Information

SUBJECT OF SPECIAL STUDY/RESEARCH WORK

SPECIAL TRAINING, CERTIFICATIONS, LICENSES

SPECIAL SKILLS, FOREIGN LANGUAGES, ETC.

 

  Military Service Record

HAVE YOU EVER SERVED IN THE U.S. ARMED FORCES?

Yes  No

BRANCH OF SERVICE

DISCHARGE DATE

RANK

 

 

 

  Former Employers (List below last three employers, starting with most recent)

NAME OF PRESENT OR LAST EMPLOYER

ADDRESS

CITY

STATE

ZIP CODE

STARTING DATE

LEAVING DATE

JOB TITLE

MAY WE CONTACT YOUR SUPERVISOR?

Yes No  

NAME OF SUPERVISOR

TITLE

PHONE

DESCRIPTION OF WORK

REASON FOR LEAVING

 

  NAME OF PREVIOUS EMPLOYER

ADDRESS

CITY

STATE

ZIP CODE

STARTING DATE

LEAVING DATE

JOB TITLE

MAY WE CONTACT YOUR SUPERVISOR?

Yes  No

NAME OF SUPERVISOR

TITLE

PHONE

DESCRIPTION OF WORK

REASON FOR LEAVING

 

  NAME OF PREVIOUS EMPLOYER

ADDRESS

CITY

STATE

ZIP CODE

STARTING DATE

LEAVING DATE

JOB TITLE

 

MAY WE CONTACT YOUR SUPERVISOR?

Yes  No

NAME OF SUPERVISOR

TITLE

PHONE

DESCRIPTION OF WORK

REASON FOR LEAVING

 

 

  References(List professional references whom we may contact)

NAME

ADDRESS

BUSINESS

PHONE

 

 

 

 

Disqualifiers

A. Criminal History: 

  1. Conviction of any felony.
  2. Conviction, plea of guilty, or no contest plea to any crime involving moral turpitude (lying, cheating, stealing).
  3. Conviction of a Class 1 or Class 2 misdemeanor of the Code of Virginia or equivalent within the last twelve months.  Convictions beyond twelve months will be reviewed on a case by case basis.
  4. Conviction, plea of guilty, or no contest plea to any sex offense or domestic assault under the laws of the Commonwealth of Virginia, another state, or the United States.
  5. Conviction of a Class 3 or Class 4 misdemeanor of the Code of Virginia or equivalent within the last twelve months.  Convictions beyond twelve months will be reviewed on a case by case basis.
  6. Conviction, plea of guilty, or no contest plea to a felony or any offense that would be a felony if committed in the Commonwealth of Virginia.
  7. Admission of felonious behavior.
  8. All prior criminal behavior, whether arrested or not, will be reviewed on a case by case basis.
  9. Any conviction taken under advisement will be reviewed on a case by case basis.

B.  Traffic Violations:

  1. Minus 6 or more points on a Virginia Operators License, or the equivalent for out of state license, at the time of application.
  2. Conviction of Driving Under the Influence, Refusal to take Blood or Breath Test, Eluding Police, or Racing. 
  3. Reckless driving or any suspension/revocation of driving priveleges within the last five years for any reason will be reviewed on a case by case basis.
  4. Any conviction taken under advismenet will be reviewed on a case by case basis. 

C.  Drug Use:

  1. Recent possession of marijuana.
  2. Any possession of Schedule I drugs as defined by the Code of Virginia 54.1-3446 (e.g. LSD, PCP, mescaline, heroin, and cocaine.)
  3. Any possession of Schedule II, Schedule III, Schedule IV or Schedule V drugs, as defined by the Code of Virignia 54.1-3448, 54.1-3450, 54.1-3452, 54.1-3454, unless prescribed by a licensed physician. 
  4. Any possession of designer drugs as defined by the Code of Virginia 54.1-3456 (e.g ecstasy).
  5. Any other drug possession will be reviewed on a case by case basis.
  6. Selling any illegal drugs. 
  7. Buying any illegal drugs will be reviewed on a case by case basis. 
  8. Must not have produced a positive result on a pre-employment drug screening, where the positive result cannot be explained to the satisfaction of the agency. 

D.  Other:

  1. Dishonorable Discharge from any military service.
  2. Less than Honorable Discharges will be reviewed on a case by case basis.
  3. De-certification law enforcement or jailor status by the Department of Criminal Justice Services, according to the Code of Virginia 15.2-1707, or similar status in other states. 
  4. Untruthfulness, falsification, or the intentional withholding of any information on any application, certificate, credential, interview, test or documents associated with the position.
  5. Cheating on any examination or testing associated with the position. 
  6. Criminal or ethical behavior unsuitable or inappropriate for a Police Officer as determined by the Appointing Authority.
  7. Failure to submit a thoroughly complete application, composite history, and other required paperwork by the assigned deadline.
  8. Failure to comply with deadlines to return requested information to the background investigator.
  9. Failure to comply with applicant’s appointment(s) without prior notification to the background investigator.
  10. Credit history with a current unsatisfactory rating.
  11. Not being a United States citizen.
  12. Background investigation indicating less than acceptable job performance with past employers.
  13. Incidents of past physical or mental abuse of anyone.
  14. Obtaining a score that is below the established standard on any test or evaluation administered during the selection process.
  15. No applicant shall be, shall have been or shall become a member of any organization which advocates the forceful overthrow of the United States government or any other organization cited as being subversive or un-American by the United States Attorney General.
  16. Tattoos or other similar body art on the ears, head, face, hands, eyebrows, eyelids, neck or tongue are prohibited.  Tattoos, or other similar body art, may only be visible on the arms, above the wrists and on the legs.  These images or wordings must not be offensive, racial, provocative, vulgar, insulting, or in poor taste.  Full arm “tattoo sleeves” shall be covered with a neutrally colored skin tone fabric cover made for the purpose of covering tattoos, or be covered by the winter uniform when approved for wear by the Department.  The Chief of Police or designee has the authority to decide when a tattoo shall be covered.
  17. The wearing of body piercing jewelry or gauge style ornamentation is prohibited. There will be no piercings of any kind in the tragus, concha, helix, lip, nose or face.

      Intentional body modification, body alterations and/or other body adornments shall not be visible.  These shall include:

  • split or forked tongue
  • foreign objects inserted in the tongue or mouth
  • intentional bodily scarring or branding
  • dermal or subdermal implants, or
  • any intentional body modifications or body alterations that pose a health hazard or impact the employee’s ability to perform their official duties

      Female officers may wear small, plain, post, clip-on, or stud type earrings. No earrings that suspend from the ear lobes or loop around any part of the ear may be worn. Earrings are not to exceed two per ear and are to be worn only in the ear lobe.

  1. Must live within a one hour drive (legally) from the Pulaski Police Department.
  2. No smoking tobacco use on or off duty.

 

Authorization

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment.”

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

 

                          

 Date                              Electronic Signature (if available)  

 
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