Thank you for your interest in joining the Pineville Police Department. Please take the time to submit your complete Employment Application below:

Position Applied For *

Date *

Applicant's Name:

Last Name *

First Name *

Middle Name *

Present Address:

Address

Street Address *

City *

State *

Country *

Postal Code *

Cell Phone *

Home Phone

Email *

Best Time to Contact *

Are You At Least 20 Years of Age? *

Yes

No

Are You an Internal Candidate? *

Yes

No

If you selected yes, please fill out the following information:

Department *

Current Title *

How Long in Current Position *

Reason For Seeking Transfer/Promotion *

Date of birth *

Are You Legally Authorized to Work in the United States? *

Yes

No

Can You Provide Proof of Eligibility? *

Yes

No

Have You Previously Been Employed with the Town of Pineville? *

Yes

No

Dates of Employment *

Previous Department *

Reason For Separation *

Are You Currently Employed? *

Yes

No

May We Contact Present Employer? *

Yes

No

Desired Salary Range *

Date Available For Work *

Employment Desired *

Full-Time

Part-Time

Full or Part-Time

Availability if Seeking Part-Time Hours *

Do You Have any Relatives Working for Town of Pineville? *

Yes

No

If so, Provide Name and Position *

Have You Ever Been Convicted of a Felony? *

Yes

No

Please Give Date, Place and Nature of the Conviction *

Any conviction will not automatically prohibit the possibility of employment. All relevant facts of a conviction will be considered as it relates to the position(s) for which an applicant is applying.

EDUCATION

High School Name and Address

Did You Graduate High School?

Yes

No

Number of High School Years Completed

Technical, Business or Trade School Name and Address

Did You Graduate Technicnal, Business, or Trade School?

Yes

No

Number of Technicnal, Business, or Trade School Years Completed

College(s) Name and Address

Did You Graduate College?

Yes

No

Number of College Years Completed

Graduate School Name and Address

Did You Graduate Graduate School?

Yes

No

Number of Graduate Years Completed

If You Did Not Graduate High School, Did You Receive Your GED?

Yes

No

Do You Have any Vocational or Business Training?

Yes

No

Please Indicate Vocational or Business Training

Do You Have any Occupational Licenses or Certificates?

Yes

No

Please Indicate Occupational Licenses or Certificates

Please Describe any Job-Related Training Received in the United States Military, if Applicable

Use this space for any additional information that we may find helpful in considering your application (ex., CDL, Computer training/appl., etc.)

List professional and vocational qualifications (i.e. publications, public speaking, volunteer experience, membership in professional organizations, civic activities and offices held). (You may exclude memberships, which would reveal gender, race, religion, national origin, age, ancestry, disability or any other protected status).

PRE-EMPLOYMENT DRUG SCREENING

A routine pre-employment drug screening test with a negative test result is required as a condition of employment. (Scheduling will be provided at the appropriate time). Please read the following statement and mark yes or no in the space provided.

Have you tested positive or refused to test, on any pre-employment drug or alcohol test for safety sensitive transportation work covered by the Department of Transportation agency drug and alcohol testing rules during the past two years? *

Yes

No

EMPLOYMENT HISTORY

Please list your work experience with you present or most recent job. Please include service in the Armed Forces and/or self employment. Attach an additional sheet if necessary.

Employer 1

Dates With Employer 1

Employer 1 Address

Employer 1 Job Title

Employer 1 Phone

Employer 1 Supervisor

Number of Employees Supervised at Employer 1

Reason for Leaving Employer 1

Employer 1 Duties

Employer 1 Starting Salary

Employer 1 Ending Salary

Employer 2

Dates With Employer 2

Employer 2 Address

Employer 2 Job Title

Employer 2 Phone

Employer 2 Supervisor

Number of Employees Supervised at Employer 2

Reason for Leaving Employer 2

Employer 2 Duties

Employer 2 Starting Salary

Employer 2 Ending Salary

Employer 3

Dates With Employer 3

Employer 3 Address

Employer 3 Job Title

Employer 3 Phone

Employer 3 Supervisor

Number of Employees Supervised at Employer 3

Reason for Leaving Employer 3

Employer 3 Duties

Employer 3 Starting Salary

Employer 3 Ending Salary

REFERENCES

Please list at least two professional references and one personal reference who can attest to your character, skills and abilities.

Reference 1

Reference 1 *

Reference 1 Address *

Reference 1 Phone Number *

Reference 1 Position *

Years Known Reference 1 *

Reference 2

Reference 2 *

Reference 2 Address *

Reference 2 Phone Number *

Reference 2 Position *

Years Known Reference 2 *

Reference 3

Reference 3 Address

Reference 3 Phone Number

Reference 3 Position

Years Known Reference 3

APPLICATION CERTIFICATION

I hereby affirm that the information provided on this application and resume, if attached, is true and complete to the best of my knowledge. I also agree that falsified information, misleading or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means it may be terminated any anytime, for any reason at all, at the will of either the Town or the employee.

I hereby understand and agree that any employee handbook or other written material provided to me upon initial employment or at anytime thereafter will not constitute an employment contract, but merely a statement of the present policies of the Town and that such policies of the Town may be amended or discontinued at anytime.

I understand this application for employment shall be considered active for a period not to exceed 6 months.

Applicant Signature *

Clear

Date of Signature *