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Application for Employment Police Clerical

First Name*
Last Name*
Address1*
City*
State*
Zip*
Phone Number*
Email Address*
Are you 18 years of age or older*
1. Yes
2. No
Have you ever been convicted of a violation of the law other than minor traffic violations*
1. Yes
2. No
Are you a U.S. Citien
1. Yes
2. No
Are you currently a Clerical Assistant for Emergency Services*
1. Yes
2. No
Type of employment desired*
1. Full Time
2. Part Time
3. Reserve
Have you ever served in the Military*
1. Yes
2. No
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I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.

I understand that the company may require me to successfully complete a pre-employment drug and alcohol test and a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests.

Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
Applicant Signature*

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