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Police Employment Form

Police Employment Form

"*" indicates required fields

Name*
Address*
Date of Birth*

Background Information

Please provide previous addresses for the past ten (10) years.
Previous Address
Previous Address 2
Previous Address 3
Previous Address 4
Previous Address 5

Martial Status And Dependents

Marital Status

Emergency Contact

Name
Address

Education and Military Experience

Work History

Please provide the last ten (10) years.
Address
Date From
Date To

Work History 2

Please provide the last ten (10) years.
Address
Date From
Date To

Work History 3

Please provide the last ten (10) years.
Address
Date From
Date To

Work History 4

Please provide the last ten (10) years.
Address
Date From
Date To

Work History 5

Please provide the last ten (10) years.
Address
Date From
Date To

Work History 6

Please provide the last ten (10) years.
Address
Date From
Date To

Work History 7

Please provide the last ten (10) years.
Address
Date From
Date To

Work History 8

Please provide the last ten (10) years.
Address
Date From
Date To
Address
Date From
Date To

Personal References

Excluding family members or work supervisors

Reference 1

Name

Reference 2

Name

Reference 3

Name

Additional Information

Drop files here or
Max. file size: 16 MB.
    Pleas attach a photo copy of your current driver's license.
    Max. file size: 16 MB.
    Please attach a copy of an academy certification or any other certificate of training you may have.

    Acceptance

    Consent
    I certify that all of the statements made in this application form are true, complete, and correct to the best of my knowledge. I understand that false or misleading statements may be sufficient grounds for not being hired, or upon discovery once hired, ground for discharge. I authorize the New Carlisle Police Department to contact previous employers, references, schools, and others deemed necessary in order to obtain information and to verify the information contained in this application. I release the New Carlisle Police Department from any liability for information released.
    Digital signature is your full name spelled out followed by the last 4 of your SSN.
    Date
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    New Carlisle

    • New Carlisle Town Hall
      124 E. Michigan St.
      New Carlisle, IN 46552

    • (574) 654-3733

    • Monday – Friday

      8:00 AM – 4:30 PM EST

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