Careers

Please fill out the application below and click the submit button. There is a downloadable version if you prefer to hand deliver the application. However, please note our hours of operation if you prefer to drop off the form. Your submitted application will be sent directly to the Chief of Police Bill Birkenhauer and processed accordingly. If you have any questions, please feel free to contact the office during regular business hours.

Application for Police Service

File size: 162.03 KB

Created: 28-12-2018

Updated: 28-12-2018

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Name
First Middle Last
Present Address
Street Address Address Line 2 City State ZIP Code
Previous Address (if present is less than two years)
Street Address Address Line 2 City State ZIP Code
Social Security Number
Phone
Are you over 21?
- Yes
- No
Contact Person #1
First Last
Emergency Number
Contact Person #2
First Last
Emergency Number
Education
List all schools attended with most recent first.
Name & Address of School
Dates attended
Did you Graduate
- Yes
- No
Course study/field
Name & Address of School
Dates attended
Did you Graduate
- Yes
- No
Course study/field
Name & Address of School
Dates attended
Did you Graduate
- Yes
- No
Course study/field
Name & Address of School
Dates attended
Did you Graduate
- Yes
- No
Course study/field
Do you plan on furthering your education?
- Yes
- No
If yes, when?
Special Skills and Qualifications
Do you speak a foreign language?
- Yes
- No
If so, which one?
Please describe your proficiency in reading, writing, speaking and understanding that foreign language.
List any special license or certification you have.
List any special skills you possess, including computers or other equipment.
Do you possess a valid driver's license?
- Yes
- No
State
Number
Have your driving privileges ever been revoked?
- Yes
- No
If so, please explain.
Military Service?
- Yes
- No
Branch
Dates
Rank(s)
Discharge?
Are you currently under any military obligation (Reserves, etc.)?
- Yes
- No
If so, please describe in full detail.
Activities
List any organizations or groups of which you have been, or are, a member, which have a direct bearing upon your qualifications for police work.
List any hobbies or interests which have a direct bearing upon your qualifications for police work.
Background
Are you willing to work a required shift, including holidays, weekends and night shifts?
- Yes
- No
Have you ever been convicted of a felony?
- Yes
- No
If yes, please describe in full detail
Are you will to submit to the following as part of your potential employment evaluation?
Drug Testing
- Yes
- No
Physical examination
- Yes
- No
Psychological examination
- Yes
- No
Polygraph examination
- Yes
- No
Criminal background check
- Yes
- No
Fingerprint check
- Yes
- No
Do you have any physical limitation that will hinder you in performing the duties of police work? If so, please explain.
Employment Record
List all previous employment. List the most recent or current job first. If a position was part time or seasonal, please list as such.
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Employer Name
Employer Address
Street Address Address Line 2 City State ZIP Code
Salary
Position
Reason for Leaving
Employment #2
List all previous employment. List the most recent or current job first. If a position was part time or seasonal, please list as such.
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Employer Name
Employer Address
Street Address Address Line 2 City State ZIP Code
Salary
Position
Reason for Leaving
Employment #3
List all previous employment. List the most recent or current job first. If a position was part time or seasonal, please list as such.
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Employer Name
Employer Address
Street Address Address Line 2 City State ZIP Code
Salary
Position
Reason for Leaving
Employment #4
List all previous employment. List the most recent or current job first. If a position was part time or seasonal, please list as such.
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Employer Name
Employer Address
Street Address Address Line 2 City State ZIP Code
Salary
Position
Reason for Leaving
Employment #5
List all previous employment. List the most recent or current job first. If a position was part time or seasonal, please list as such.
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Employer Name
Employer Address
Street Address Address Line 2 City State ZIP Code
Salary
Position
Reason for Leaving
Employment #6
List all previous employment. List the most recent or current job first. If a position was part time or seasonal, please list as such.
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Employer Name
Employer Address
Street Address Address Line 2 City State ZIP Code
Salary
Position
Reason for Leaving
Personal References
List three (3) non-work related references (may be relatives and/or friends)
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Association
Personal Reference 2
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Association
Personal Reference 3
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Association
Work-Related References
List three (3) work-related references (may not be a relative)
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Association
Work-Related Reference 2
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Association
Work-Related Reference 3
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Association
Pertinent Facts
List any fact you would like to voluntarily present to us in which, in your opinion, may help us to evaluate your qualifications as a police applicant.
I certify that there are no misrepresentations, omissions, or falsifications in the foregoing statements and answers and that the entries made by me are true, complete and correct to the best of my knowledge and belief and are made in good faith. I further agree to consent, in advance, to be summarily discharged without cause or hearing, if any of the above information contains any misrepresentation or falsification or any material information has been omitted. In the event that I am employed by the City of Highland Heights Police Department, I agree to comply with all of its orders, rules and regulations. I hereby authorize my former employers to give any information regarding my employment with them, and in addition, to furnish any other information they may have concerning me. I hereby release any such person from any and all liability for any damage whatsoever incurred in furnishing such information.
Signature*
Date
MM slash DD slash YYYY

Application for Police Service

Education

Special Skills and Qualifications

Activities

Background

Employment Record

Employment #2

Employment #3

Employment #4

Employment #5

Employment #6

Personal References

Personal Reference 2

Personal Reference 3

Work-Related References

Work-Related Reference 2

Work-Related Reference 3

Pertinent Facts