Police Department Employment Application

2. The City of Brookville is an Equal Opportunity Employer, and maintains a policy of Equal Employment Opportunity for all employees and applicants. The City of Brookville does not discriminate in employment or the provision of services on the basis of race, color, religion, gender (sex), national origin and ancestry, age, disability, sex (wages), military status, genetic information, pregnancy, or any other characteristic protected by federal or state law.

   The information provided in this application will be used to determine your suitability to continue in the hiring process with the City of Brookville. Please submit one application per position to the address indicated on the job posting or examination announcement. This application will be considered only if it is submitted in response to a current job opening. If you wish to be considered for future job openings with the City of Brookville, you must fill out another job application in response to that specific job opening. Copies are acceptable. Applications lacking sufficient information will not be processed. Please be sure to complete the entire application and ensure your application is received by the closing date. Also note that, once submitted, this completed form will be subject to all applicable public records laws. If you are selected to continue in the hiring process, you will be required to complete additional forms and provide additional information, in addition to updating any information provided in this application.

   The information provided in this application will be used to determine your suitability to continue in the hiring process with the City of Brookville. Please submit one application per position to the address indicated on the job posting or examination announcement. This application will be considered only if it is submitted in response to a current job opening. If you wish to be considered for future job openings with the City of Brookville, you must fill out another job application in response to that specific job opening. Copies are acceptable. Applications lacking sufficient information will not be processed. Please be sure to complete the entire application and ensure your application is received by the closing date. Also note that, once submitted, this completed form will be subject to all applicable public records laws. If you are selected to continue in the hiring process, you will be required to complete additional forms and provide additional information, in addition to updating any information provided in this application.

4. Applicants with disabilities may contact Human Resources to request and arrange for accommodations. If you need assistance to accommodate a disability, please contact Human Resources.

   Human Resources

6. All information provided on this application and at any stage of the hiring process must be truthful and complete. Any false statements, material misrepresentations, or deliberate omissions of a fact or facts in this application, or at any stage of the hiring process, shall be considered sufficient cause for refusal to hire and shall be considered sufficient cause, if employed, for termination from employment.

8. Name

9. Email Address

11. Address

13. City

14. State

15. Zip Code

17. Phone Number

18. Alternate Phone Number

20. Are you legally eligible to work in the US?

    1. Yes
    2. No

22. Will you be 21 years of age or older on or prior to appointment?

    1. Yes
    2. No

26. Employment History

    It is required that you complete all sections of your employment history below, beginning with the most recent employment and working back. If you need additional space to provide complete information, attach a letter-sized sheet (8-½” X 11”) to this application, which should include in the caption the position you are applying for and your name.

    It is required that you complete all sections of your employment history below, beginning with the most recent employment and working back. If you need additional space to provide complete information, attach a letter-sized sheet (8-½” X 11”) to this application, which should include in the caption the position you are applying for and your name.

28. Do not use "See Resume" as a substitute for completing your employment history.

32. Position Title(s)

33. Company / Employer

35. Date Started
    Date Started

36. Date Ended
    Date Ended

38. Address

40. City

41. State

42. Zip Code

44. Phone Number

45. Immediate Supervisor

47. Hours Per Week

48. Starting Salary

49. Current Salary

51. Duties

53. Reason For Leaving

55. May We Contact this Employer?

    1. Yes
    2. No

59. Position Title(s)

60. Company / Employer

62. Date Started
    Date Started

63. Date Ended
    Date Ended

65. Address

67. City

68. State

69. Zip Code

71. Phone Number

72. Immediate Supervisor

74. Hours Per Week

75. Starting Salary

76. Current Salary

78. Duties

80. Reason For Leaving

82. May We Contact this Employer?

    1. Yes
    2. No

86. Position Title(s)

87. Company / Employer

89. Date Started
    Date Started

90. Date Ended
    Date Ended

92. Address

94. City

95. State

96. Zip Code

98. Phone Number

99. Immediate Supervisor

101. Hours Per Week

102. Starting Salary

103. Current Salary

105. Duties

107. Reason For Leaving

109. May We Contact this Employer?

     1. Yes
     2. No

113. Position Title(s)

114. Company / Employer

116. Date Started
     Date Started

117. Date Ended
     Date Ended

119. Address

121. City

122. State

123. Zip Code

125. Phone Number

126. Immediate Supervisor

128. Hours Per Week

129. Starting Salary

130. Current Salary

132. Duties

134. Reason For Leaving

136. May We Contact this Employer?

     1. Yes
     2. No

140. Education

144. High School

146. Name

147. Location (City, State)

148. Did you Graduate?

     1. Yes
     2. No

150. Check Year Completed

     1. 9
     2. 10
     3. 11
     4. 12

151. Obtained GED?

     1. Yes
     2. No
     3. N/A

155. College / University / Trade Tech

157. Name

158. Location (City, State)

159. Major

161. Check Year Completed

     1. 1
     2. 2
     3. 3
     4. 4
     5. 5
     6. 6

162. Number of Quarter / Semester Hours Completed

164. Did You Graduate?

     1. Yes
     2. No

165. Degree Received

169. College / University / Trade Tech

171. Name

172. Location (City, State)

173. Major

175. Check Year Completed

     1. 1
     2. 2
     3. 3
     4. 4
     5. 5
     6. 6

176. Number of Quarter / Semester Hours Completed

178. Did You Graduate?

     1. Yes
     2. No

179. Degree Received

183. College / University / Trade Tech

185. Name

186. Location (City, State)

187. Major

189. Check Year Completed

     1. 1
     2. 2
     3. 3
     4. 4
     5. 5
     6. 6

190. Number of Quarter / Semester Hours Completed

192. Did You Graduate?

     1. Yes
     2. No

193. Degree Received

197. Position Related Skills

199. Office Skills

200. Typing Speed

202. Computer Skills

204. Other Skills

206. Language(s)

208. Language(s) Spoken

209. Language(s) Written

211. Experience, Skills, or Qualifications that You Believe Make You Suitable for this Position

215. Certifications, Licenses & Other

217. General

     1. State of Ohio Driver's License
     2. High School Diploma or GED Equivalent

218. Commercial Driver's License

     1. Yes
     2. No

220. CDL A

     1. CDL A
     2. Tanker Endorsement

221. Expiration Date

223. CDL B

     1. CDL B
     2. Tanker Endorsement

224. Expiration Date

226. CDL C (Passenter-Bus)

     1. CDL C (Passenter-Bus)

227. Expiration Date

229. Police Related

     1. OPOTC certificate meeting the requirements described in Section 109: 2-1-12(D) of the Ohio Administrative Code

230. Expiration Date

232. Fire Related

     1. State of Ohio Firefighter Certification
     2. Firefighter II (240 hour)
     3. State of Ohio EMT-P (Paramedic) Certification
     4. Firefighter Physical Assessment (Agility) Certification

234. Firefigher II Certification Expiration Date

236. State of Ohio EMT-P Certification Expiration Date

238. Firefigher Physical Assessment Certification Expiration Date

240. Other

     Certifications and/or licenses that you currently hold that you feel are relevant to the position for which you are applying, such as Electrical, HVAC, Plumbing, First Aid, FEMA-NIMS, etc.

     Certifications and/or licenses that you currently hold that you feel are relevant to the position for which you are applying, such as Electrical, HVAC, Plumbing, First Aid, FEMA-NIMS, etc.

242. Other Certification

243. Expiration Date

245. Other Certification

246. Expiration Date

248. Other Certification

249. Expiration Date

251. Other Certification

252. Expiration Date

254. Other Certification

255. Expiration Date

257. Other Certification

258. Expiration Date

260. Other Certification

261. Expiration Date

263. Other Certification

264. Expiration Date

266. Other Certification

267. Expiration Date

271. Candidate Certification

273. I certify that I have read, understand, and agree and attest to each of the following statements:

275. 1. All of the information that I have supplied above in my application are true, accurate, and complete, to the best of my knowledge, and that I have not knowingly withheld any information.

277. 2. I understand that any false statements, material misrepresentations, or deliberate omissions of a fact or facts in this application, or during the hiring process, shall be considered sufficient cause for refusal to hire.

279. 3. I understand that any false statements, material misrepresentations, or deliberate omissions of a fact or facts in this application, or during the hiring process, shall be considered sufficient cause if employed, for my termination from employment.

281. 4. I understand that this application will be considered only if it is submitted in response to a current job opening, and that if I wish to be considered for future job openings with the City, I must fill out another job application and submit it in a timely manner for that(those) specific job opening(s).

283. 5. I understand that the City of Brookville will make a thorough investigation of my entire work and personal history and may verify all data given in my application for employment, related papers, or oral interviews. I authorize such investigation and the giving and receiving of any information requested by the City of Brookville and I release from liability any person giving or receiving any such information.

285. 6. I understand that information may be obtained through personal interviews with my neighbors, friends or others with whom I am acquainted. This includes information as to my character, general reputation, personal characteristics and mode of living.

287. 7. I authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the duties of a job I am being considered for prior to employment or, in the future, during my employment with the City of Brookville.

289. 8. I understand that although management makes every effort to accommodate individual preferences, business needs may, at times, make the following conditions mandatory: overtime, shift work, or a rotating work schedule other than Monday through Friday. I understand and accept these as conditions of my continuing employment.

291. 9. I understand that if I am offered employment it will be contingent upon submitting to and passing a post-offer physical examination, which may include drug and alcohol screening, and that if I fail, it will be grounds for the contingent offer being withdrawn.

293. 10. I understand that information received by the City of Brookville regarding my application for employment is subject to the State of Ohio Public Records Act.

295. 11. I further understand that this is an application for employment and that no employment contract is being offered.

297. I have read and understand the above.

299. Electronic Signature Agreement

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
301. Electronic Signature

302. Date
     Date

Leave This Blank:


303. 1. Receive email copy
304. Email address

     This field is not part of the form submission.

305. Submit

* indicates a required field