Employment

First Name*

Last Name*

Date of Birth*
-- Select Month --JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember-- Select Day --12345678910111213141516171819202122232425262728293031-- Select Year --19401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010

Place of Birth*

Phone*

Email*

Address*

City*

Zip*

Are You Applying For*
CommissionedNon-Commissioned

Desired Work Time*
Part TimeFull Time

Are You Licensed?*
CommissionedNon-CommissionedNot Registered

Type Of DPS Certification*
CommissionedNon-CommissionedNot Certified

When Can You Start Work?*

Desired Rate Per Hour

Preferred Shifts
MorningEveningNight

Days Available To Work*
MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Are You Currently Employed?*
YesNo

Current Employer
Company Name

Job Title

Contact Person

Phone Number

Previous Employer
Company Name

Job Title

Contact Person

Dates Employed

Phone Number

Last Wage

Reason For Leaving

Do You Have A Valid Driver's License?*
YesNo

List Any Tickets Or Accidents You Have Had In The Past 3 Years. Reply none if none.*

Has Your License Ever Been Suspended?*
YesNo

Have You Ever Been Convicted Of A DWI?*
YesNo

Do You Have Your Own Transportation?*
YesNo

Are Your Willing To Drive To Your Post?*
2 To 20 Miles20 Miles & Up

Have You Been Convicted In The Past 5 Years?*
YesNo

Education Completed*
High SchoolCollegeTechnical School

School Name*

Type Of Degree

Military Service
YesNo

What Branch Did You Serve?

Highest Rank/Rating Achieved

Type Of Discharge

*Mandatory Fields