City of Dickson Police Department Application for Employment

City of Dickson Police Department
202 South Main Street
Dickson, TN 37055
615-446-5403

Application For Employment
An Equal Opportunity Employer
Please read these statements carefully before you complete this application:

We offer equal employment opportunities to all persons without reguard to race, religion, age, sex, national origin, disability, veteran or marital status.

The use of this form does not mean there are positions open and does not obligate us in any way. This application will remain on active file with the City of Dickson Police Department for a period of one year from the date of the application.

Interdepartmental transfers and promotions are selected based on applicant's job qualifications, quality of work, experience, general aptitude, licensure and support and compliance of policies and procedures outlined by each department and the city.
Acknowledgement
With regard to my employment application, I understand that as a part of normal procedure for processing employment applications and employment requests, a routine inquiry may be made to ascertain information on character, general reputation, credit, personal characteristics, etc.. I understand that the City of Dickson or an investigative services firm employed by the City may conduct this inquiry. I authorize such investigation and acknowledge that information that information on the nature and scope of such report, if one is made, will be available upon my written request. I agree to hold harmless the city from liability for information that may appear on such reports.

I further authorize the City of Dickson Police Department or other agency on its behalf to contact references and employeers listed, and also authorize release of records or information in connection with a criminal record search in connection with my history, past or present.

I understand this application will be given consideration buts its receipt does not imply that I will be employed. If I should enter into employment with the City of Dickson Police Department, I agree to be subject to rules and regulations governing municipal personnel.

I herby affirm that to the best of my knowledge all information I am furnishing is true and correct. I understand that if any information requested in this application is false or omitted with the effect of misrepresentation, it will be sufficent grounds for my immediate termination from employ of the City of Dickson.
Name

First NameMiddle and Last Name
Signature

Employment Experience

List your most recent employer first
Employer
Contact name:
Contact email address (if known):
example@example.com
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Job Title
Dates employed:
Starting and Ending Hourly Rate / Salary:
Work performed:
Reason for leaving:

Employment Experience (2)

List your most recent employer first
Employer
Contact name:
Contact email address (if known):
example@example.com
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Job Title
Dates employed:
Starting and Ending Hourly Rate / Salary:
Work performed:
Reason for leaving:

Employment Experience (3)

List your most recent employer first
Employer
Contact name:
Contact email address (if known):
example@example.com
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Job Title
Dates employed:
Starting and Ending Hourly Rate / Salary:
Work performed:
Reason for leaving:

Employment Experience (4)

List your most recent employer first
Employer
Contact name:
Contact email address (if known):
example@example.com
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Job Title
Dates employed:
Starting and Ending Hourly Rate / Salary:
Work performed:
Reason for leaving:

Employment Experience (continued)
Please explain any gaps in your employment, other than those due to illness, injury or disability.
Have you ever been discharged or requested to resign from a job?
If "yes" above, please explain:

Education Background
High School
High School Location:
Did you graduate?
College:
College Location:
Course of study?
Did you graduate?
Degree or diploma
Vocational Training / Other:
College Location:
Course of study?
Did you graduate?
Degree or diploma
Continuing Education:

Special Training or Skills
Languages or machine operation:
Special Licensure / Certification (please provide dates of expiration if applicable)
Do you have any license or certifications that have been revoked, suspended or voluntarily relinquished?
Any other applicable training to the postion being applied for:
Social Security Number:
The City of Dickson will make reasonable efforts to safeguard the privacy of this information and will use it only for employment purposes.

References
List the names and numbers of three business / work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal referances who are not related to you.

Reference #1
Name

First NameLast Name
Job Title:
Relationship to you:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email (if known)
example@example.com
Years known:

Reference #2
Name

First NameLast Name
Job Title:
Relationship to you:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email (if known)
example@example.com
Years known:

Reference #3
Name

First NameLast Name
Job Title:
Relationship to you:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email (if known)
example@example.com
Years known:

Applicant Statement
I understand that any offer of employment may be contingent on the successful completion of a test for alcohol and drug screening and I will upon request sign all necessary consent forms. I agree to take any such physical or medical examinations requested during my employment to determine my "fitness for duty". I understand that all employees, due to the critical nature of their work and the impact on the general public, may be asked to submit to random substance screening at the discretion of the city or in order to comply with mandated testing. I understand that refusal to submit to any physical or medical examination ordered by the city is grounds for rejection for employment or for disciplinary action up to and including immediate discharge. I further understand that any information obtained through such exams may be retained by the city and is exclusively the city's property.

I consent to submit to and cooperate in any questioning or searches of my assigned vehicle, if applicable, or locker or storage area, or bags or other belongings on or in the city's property that the city at its discretion may request. I further understand that the refusal to submit to or cooperate in such procedures may be deemed grounds for disciplinary action up to and including immediate discharge.

I agree to notify the city if, because of physical or mental disability. I require an accommodation to complete the application process, to complete any pre-employment testing, or if employment is offered, to perform any essential function of the job for which I have applied.

I agree to be employed on a 180 day introductory basis and I understand that I may be dismissed at any time during this period at the discretion of the employer. This also pertains to Police and Fire Department employees who work at 180 day introductory basis after formal training. If employed, I agree to observe all present and subsequently issued personnel rules and policies. These rules and policies are intended to guide the organization in its relationship with its employees. They are not a contract of employment, and I do not construe them as such. I understand that the city may revise policies or procedures, in whole or in part, at any time, with or without notice.

I certify that the information given by me in this application is true in all respects, and I agree that if employed and it is found to be false in any way that I may be subject to dismissal without notice, if and when discovered. I authorize the use of any information in this application to verify my statements, and I authorize past employers, references, and any other or all persons to answer all questions asked concerning my ability, character, reputation, and previous

employment record. I release all such persons from any liability or damages for having furnished such information. I further agree and understand that employment is terminable at the will of either the employee or employer.

I understand that, if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States as required by federal immigration laws.

The City of Dickson does not tolerate unlawful discrimination or harassment based on sex, race, color, religion, national origin, citizenship, age disability, or any other protected status under applicable federal, state or local law. No question on this application is used to limit or exclude an applicant from employment consideration on any basis prohibited by applicable federal, state or local law.
How did you hear about this position

Other
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

An Equal Opportunity Employer

Acknowledgement

Equal Employment Opportunity Self-Identification Survey

Employment Experience

Employment Experience (2)

Employment Experience (3)

Employment Experience (4)

Employment Experience (continued)

Education Background

Special Training or Skills

References

Reference #1

Reference #2

Reference #3

Applicant Statement