Police Reserve Officer Application

Personal Information

Position Title:

First Name:

Last Name:

Address:

Address 2:

City:

State:

ZIP

Email:

Home or Cell Phone Number:

Alternate Phone Number:

Education

High School / University / Vocational / Other:

Date Started:

Degree Received:

Date Received:

High School / University / Vocational / Other:

Date Started:

Degree Received:

Date Received:

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Employment

Please enter information on at least your last two employers.

Employer:

Is this a current employer or past employer?

Current Employer

Past Employer

Start Date:

Position Title:

Employer Address (Street, City, State, ZIP):

Employer Phone Number:

May we contact this employer?

Yes

No

Supervisor Name:

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Other:

Certificates and Licenses:

Skills:

Additional Information:

References:

Please list people you have known for at least three years consisting of two peers and two adults.

Full Name:

Title:

Address:

Address 2:

City:

State:

ZIP:

Email Address:

Phone Number:

Full Name:

Title:

Address:

Address 2:

City:

State:

ZIP:

Email Address:

Phone Number:

Remove

Full Name:

Title:

Address:

Address 2:

City:

State:

ZIP:

Email Address:

Phone Number:

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Supplemental Questions

If a question dows not apply to you, please place N/A in the appropriate space.

Are you at least 18 years old?

Yes

No

Do you possess a high school diploma or GED?

Yes

No

Do you have a good driving record?

Yes

No

Not Applicable

Do you possess a valid MN driver's license?

Yes

No

Have you ever been convicted as an adult of a felony or gross misdemeanor for which a jail sentence of more than 30 days could have been imposed?

Yes

No

Have you been a Reserve Officer for another City or County?

Yes

No

Do you have any public safety related volunteer or professional experience?

Yes

No

Are you trained in First Aid, Firest Responder, or EMT?

Yes

No

Are you able to attend the monthly training meeting that is held on the third Monday of each month (except for December) from 7pm to 9pm?

Yes

No

Please explain why you would like to become a Police Reserve Officer.

Where did you learn of this opportunity?

You may choose to upload a resume or cover letter here.

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Agreements

I certify that all answers to the above question are true and understand that any false information or omission of information from this application will be cause for rejection of this application or termination without notice.

I understand the above agreement.

Signature

By signing below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

Applicant Signature

Clear