Applicant Information

Full Name*:

Date*:

Address*:

Email Address*:

Position Desired

Position Applying For:
Police OfficerReserve Officer

Available Start Date:

Are you a U.S. Citizen?*
YesNo

Are you at least 21 years of age?*
YesNo

Do you have a valid Missouri Driver’s License?*
YesNo

Driver’s License Number:

Have you ever been convicted of a felony?*
YesNo

(If yes, explain):

Education

Law Enforcement Certification

Are you Missouri POST Class A Certified?*
YesNo

POST License Number (if applicable):

Academy Attended:

Date Completed:

Employment History (List your last three employers. Attach resume if available.)

Employer 1:

Company:
Job Title:
Supervisor:
Phone:

Reason for Leaving:

Employer 2:

Company:
Job Title:
Supervisor:
Phone:

Reason for Leaving:

Employer 3:

Company:
Job Title:
Supervisor:
Phone:

Reason for Leaving:

Military Service

Branch:

Rank at Discharge:
Type of Discharge:
If other than honorable, explain:

References (List three professional references not related to you.)

Authorization and Signature

I certify that my answers are true and complete to the best of my knowledge. I understand that any false, omitted or misleading information may result in disqualification or termination. I authorize investigation of all statements contained in this application.

Signature*:

Date*: