Crete Police – Application for Lateral Hires

Step 1 of 4

INSTRUCTIONS: Applicant must complete application accurately. All statements are subject to verification. If writing space provided is inadequate, use an additional sheet at the end of the application and identify additional information by page number and question number. Use the term “N/A” if the question does not apply. Be certain to list the area code for each telephone number requested.

E-Mail application to: Kcarteryoung@villageofcrete.org

Date of Application *

Position Applied for *

Full Time
Lateral
Part Time

Personal Data

Name *

First

Middle

Last

Cell Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Date of Birth//

If you advance in the application process, are you able to present proof of citizenship? *

List any other names/aliases you have used, or been known by (include maiden name, if applicable)

Emergency Contacts

Person(s) to be notified in case of an emergency.

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Emergency Contact 1: Name

First

Last

Emergency Contact 1: Phone

Emergency Contact 1: Relationship

Emergency Contact 1: Address

Address Line 1

Address Line 2

City

State

Zip Code

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Emergency Contact 2: Name

First

Last

Emergency Contact 2: Phone

Emergency Contact 2: Relationship

Emergency Contact 2: Address

Address Line 1

Address Line 2

City

State

Zip Code

Education and Training

List the various schools you have attended and other information requested

Have you graduated from High School and/or College? If so, select below. *

High School or GED Equivalent
College/University or Trade School
Other College/University or Trade School

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List other formal education you may have including special training courses:

List any professional licenses or certificates you hold or have held:

Military

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Have you ever served in any military organization of the US? *

Driving History

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Can you operate an automobile? *

Do you possess a valid Operator's License? *

Driver's License Number *

Expiration Date *

List all other states in which you hold or have held an Operator’s License

License Numbers and Expiration Dates

Security Data

Have you ever been convicted of a criminal offense? *

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Employment History

Employer 1

From: *//

To: *//

Title: *

Supervisor: *

Most recent/current employer: *

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Summarize the nature of work performed and responsibilities: *

Employer Phone: *

Job Title: *

Reason for leaving: *

Employer 2

From: //

To: //

Title:

Supervisor:

Most recent/current employer:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Summarize the nature of work performed and responsibilities:

Employer Phone:

Job Title:

Reason for leaving:

Employer 3

From: //

To: //

Title:

Supervisor:

Most recent/current employer:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Summarize the nature of work performed and responsibilities:

Employer Phone:

Job Title:

Reason for leaving:

Employer 4

From: //

To: //

Title:

Supervisor:

Most recent/current employer:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Summarize the nature of work performed and responsibilities:

Employer Phone:

Job Title:

Reason for leaving:

Are there any employers you do not want us to contact? Please explain:

Have you ever taken a pre-employment exam from any state, county or municipal hiring board? *

Pre-Employment Exam Information

Have you ever been a Public Safety employee or held a similar position? *

Were you ever discharged or forced to resign because of misconduct or unsatisfactory service, or while under investigation? *

References

Relationship

Explain your reason for applying for this position: *

I hereby certify that there are no willful misrepresentations, or falsifications in this questionnaire, and all my answers are true and correct to the best of my knowledge and belief.

It is understood and agreed upon that any misrepresentation or omission by me on this application will be sufficient cause for cancellation of this application and/or separation from the employer’s service if I have been employed.

I give the employer the right to investigate all references and to secure additional information about me. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

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Signature *

Date / Time *

Date

Time

Date / Time *

The undersigned fully understands that part of the testing process may require taking a polygraph examination. This examination may cover the following areas:

Theft from your previous place of employment
Buying or selling stolen property
Commission of any serious crimes
Shoplifting
Work and Medical history
Use of alcoholic beverages
Use or sale of illegal drugs
Driving record
Paying or receiving bribes or kickbacks
Use of excessive force against another person

The undersigned acknowledges that part of the testing process requires taking a psychological examination, a medical examination, and a drug-screening test; to determine fitness and recommendation for a position in law enforcement. The drug test is to detect the presence or absence of habit forming drugs, including, but not limited to, marijuana, cocaine, and heroin.

I acknowledge that the results of the above tests will be considered by the Village of Crete Fire and Police Commission in its evaluation of my application, and hereby consent both to the testing and such use of the results as may be reasonably necessary in the evaluation of my application.

The undersigned hereby releases, remises, and discharges the Village of Crete, Illinois, a municipal corporation, their Fire and Police Commission, its officers, servants, agents, and employees, of and from any and all injuries, losses, and damages to my person that shall have been caused, or at any time may arise as a result of the examinations for the position of Patrol Officer conducted by the Village of Crete. The intention hereof being to completely, absolutely, and finally release said municipality, their Fire and Police Commission, its officers, servants, agents, and employees, of and from any and all liabilities arising wholly or partially from the cause aforesaid.

The undersigned fully understands, and agrees, that all tests and results thereof, become the property of the Fire and Police Commission of the Village of Crete. Additionally, the undersigned also understands and acknowledged that all said testing materials, and the results thereof, are not subject to review.

I hereby agree toabide by all the rules and regulations of the Fire and Police Commission of the Village of Crete, Illinois during and after all examination programs.

Signature *

Printed Name: *

First

Middle

Last

Personal Data

Emergency Contacts

Person(s) to be notified in case of an emergency.

Education and Training

High School or GED Equivalent

College/University or Trade School

Other College/University or Trade School

Military

Driving History

Security Data

Employment History

Employer 1

Employer 2

Employer 3

Employer 4

References

Reference Name

Address