Police Officer App

Human Resources Department City of Big Spring 310 Nolan Street Big Spring, Texas 79720 (432) 264-2345

Dear Applicant: The City of Big Spring appreciates your interest in our vacant position. We are excited about receiving more information from you and would like you to complete the enclosed employment application packet. Please follow all the instructions in the application packet and make sure that the application is fully complete. Please return completed packet to the Human Resource Department at your earliest convenience.

YOU ARE REQUIRED TO INCLUDE THE FOLLOWING WITH YOUR PACKET •

Ensure that you have included your job history for the past five (5) employers. If your five (5) listed employers do not cover a time period of at least ten (10) years, please use the supplemental employment page to record your remaining employment history. Use additional pages as necessary (the format MUST include all requested information).

•

Proof of highest education (diploma, General Educational Development [GED], college degree(s) and/or transcript(s)).

•

A DD-214 Member 4 (long form) [if you have been in the military].

•

NGB Form 22 (if you have been in the National Guard).

Again, thank you for your interest with the City. Sincerely,

John Medina John Medina Human Resource Director www.mybigspring.com

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POLICE OFFICER – CERTIFIED AND NON-CERTIFIED Department: Police Department Salary: $16.253/$15.470 per Hour FLSA Classification: Non-Exempt Shift(s): Twelve (12) hours 6:00 a.m. thru. 6:00 p.m. & 6:00 p.m. thru. 6:00 a.m. The shifts work as follows: A shift works: Sunday, Wednesday, Thursday on week 1 and Monday, Tuesday, Friday, Saturday week 2

Rotating Every 28 Days

JOB SUMMARY: This position is responsible for the enforcement of federal, state, and local laws, the protection of life and property and preserving the peace. MINIMUM QUALIFICATIONS: You must be twenty one (21) years of age to hold a Texas Peace Officers License; thus, that translates to, you must be at least be twenty one (21) years of age the Day You Take the Test to become a Texas Certified Police Officer. In-addition to the following: Graduation from High School or GED. In-addition, accordance with the TEXAS COMMISSION ON LAW ENFORCEMENT STANDARDS, applicants with a GED requires twelve (12) hours of College Credits to be qualified to enroll in a Police Academy to meet TEXAS COMMISSION ON LAW ENFORCEMENT STANDARDS, along with the ability to meet other current requirements set forth by the Texas Commission of Law Enforcement Officers Standards and Education. Possession of or ability to readily obtain a valid driver’s license issued by the State of Texas for the type of vehicle or equipment operated. Ability to read, write and perform mathematical calculations at a level commonly associated with the completion of high school or equivalent. No experience requirements. No illegal drug use, No arrest record with higher than a class C misdemeanor, Meets or exceed the physical agility requirements of the department. Demonstrate proficiency with handgun, and shotgun during scheduled testing with the department. MAJOR DUTIES: Attendance is an essential job function to perform the duties of this position. Patrols an assigned zone on foot, on bicycle, and by vehicle to detect and deter criminal activity and traffic violations. Responds to calls relayed by communications officers, including domestic disputes, assaults, burglaries, traffic accidents, lost or missing persons searches, public service duties, stranded motorists, and others. Conducts preliminary investigations into traffic accidents and other incidents, including interviewing victims, complainants and witnesses, gathering information and evidence, and securing crime scenes. Apprehends, arrests, and processes offenders, including fugitives; subpoenas witnesses; serves warrants. Provides assistance and backup support to other officers and emergency service providers as necessary. Assists motorists. May provide first-aid and CPR to victims as necessary. Provides traffic direction as needed for special events 2

such as parades, funerals, athletic events, and school crossings. Testifies in judicial proceedings as necessary. Completes all required reports and forms, including accident and incident reports. Inspects and maintains assigned patrol car, uniform, and equipment. May serve as Hazardous Materials Technician. Serves criminal and courtrelated paper work. Attends ongoing training classes as required. May serve as a member of the department’s SORT team, as a field training officer for the department, as School Resource Officer/DARE Officer; provides DARE instruction to school children. Performs other related duties as assigned. SKILL, KNOWLEDGE AND ABILITIES REQUIRED BY THE POSITION: Knowledge of relevant federal and state laws, criminal and traffic codes, search and seizure laws, city ordinances, and department policies and procedures. Knowledge of traffic accident investigation techniques and procedures. Knowledge of the geography and streets of the city. Knowledge of first-aid and CPR techniques. Knowledge of the court system and judicial procedures. Skill in operating police vehicles, firearms, and emergency equipment. Skill in operating radios and communications equipment. Skill in operating radar equipment. Skill in evidence packaging. Skill in restraining persons without causing physical harm. Skill in controlled substance field-testing. Skill in the use of a computer. Skill in oral and written communication. SUPERVISORY CONTROLS: The Sergeant - Patrol assigns work in terms of general instructions. Work is reviewed for accuracy, compliance with established procedures, and the nature and propriety of the final results. GUIDELINES: Guidelines include state and federal laws, traffic laws, city ordinances, court rulings, constitutional guidelines, training manuals, department policies and procedures, and supervisory instructions. These guidelines are generally clear and specific, but require some interpretation in application. COMPLEXITY: The work consists of related law enforcement duties. The varied nature of calls and the potential for emergencies contribute to the complexity of the work. SCOPE AND EFFECT: The purpose of this position is to protect life and property and enforce federal, state, and local laws. Successful performance helps ensure the safety and well-being of citizens and contributes to the efficient and effective operation of the department. PERSONAL CONTACTS: Contacts are typically with co-workers, other city employees, other emergency service providers, court system personnel, attorneys, judges, medical personnel, law enforcement officers from other agencies, and the general public. PURPOSE OF CONTACTS: Contacts are typically to give or exchange information, provide services, interview persons, resolve problems, and negotiate or settle matters. 3

PHYSICAL DEMANDS: The work is typically performed while sitting, standing, walking, running, bending, crouching or stooping. The employee occasionally lifts light or heavy objects, uses equipment requiring a high degree of dexterity, and must be able to distinguish between shades of color and use the physical force necessary to arrest and restrain persons. WORK ENVIRONMENT: The work is performed indoors, in a vehicle, and outdoors. The employee may be exposed to inclement weather, infectious diseases, and life-threatening situations. The work requires the use of protective clothing and devices. SUPERVISORY AND MANAGEMENT RESPONSIBILITY: This position may serve as relief supervisor in the absence of the Sergeant.

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ENTRY LEVEL PHYSICAL AGILITY TEST Each event is timed and applicants must complete the event within the prescribed time limit to proceed to the next event and remain eligible for employment consideration. No applicant will be permitted to re-take any portion of the physical agility they may fail until the next testing time. Persons who are unable to meet the time limits are to contact the City Human Resources Department for the next testing date and time. Physical agility testing will consist of the following events in the below order.

1. TRIGGER PULL: 15 seconds per hand – Using a departmental issue weapon, the applicant will pull the trigger thru 12 times with the strong hand using the index finger. Weapon will be held at shoulder point, away from the body. Exercise repeated with weak hand. (Applicant may use his/her own personal weapon. Prior departmental approval of the weapon by the departmental armorer is required). 2. SHOTGUN LOAD: 30 seconds – Using a department Remington 870 shotgun, the applicant will load the shotgun with four (4) dummy rounds and cycle all shells through the weapon while at shoulder point. 3. 220-YARD RUN: 42 seconds – The applicant will run 220 yards over a designated course 4. 165 LB DUMMY DRAG: 35 seconds – The applicant will begin seated in a police vehicle with the door closed. The applicant will exit the vehicle, run to a simulated person weighing 165 lbs., and drag the dummy completely past the front bumper of the vehicle. Distance is 75 feet. 5. OBSTACLE COURSE: 80 seconds – Applicant will drive a police vehicle to a specified location, stop and secure it. Applicant will exit the vehicle running to and proceeding through the tires, hitting each tire. Applicant will then proceed to and through a tunnel. Upon exiting, they will proceed to a set of four (4) foot bars, going over the first bar. They will then zigzag between the remaining bars, not touching the bars. The applicant will proceed to the incline wall, climbing it and touching the top rung, crossing to the opposite side, climb down and proceed to a four (4) foot wall, go over it and run past the finish line. During the obstacle course, the applicant will be expected to locate and identify verbally, three (3) items. A five (5) second penalty will be accessed for each item not located. YOU MUST BRING TENNIS SHOES & GYM CLOTHES FOR PHYSICAL AGILITY TESTS. Lonnie Smith Chief of Police

400 East 4th, Big Spring, Texas 79720-2635

(432) 264-2550 5

Fax (432) 264-2415

POLICE DEPARTMENT’S APPLICANT PACKET CHECKLIST

APPLICANT’S FULL LEGAL NAME:

LAST

SOCIAL SECURITY #:

FIRST

MIDDLE

TODAY’S DATE: Initials

City of Big Spring Original Employment Application City of Big Spring Drug & Alcohol Policy Form City of Big Spring EEO Compliance Form Authorization for Release of Information Agreement (to be signed in the presence of a Notary Public) Pre-Employment Psychological Evaluation Waiver of Confidentially (Only for Police, Communication and Jailer Applicants) Willingness Questionnaire (Only for Police Officer Applicants) Copy of High School Diploma or GED Certificate

(Plus Highest Level completed ie. Associates, Bachelors, Masters, Doctorates)

Military DD214 Member 4 copy and/or NGB FORM 22 (If applicable) Copy of Valid State Driver’s License Copy of Social Security Card Certified Copy of Law Enforcement Academy Certification (Location) Personal History Questionnaire (to be submitted upon successful completion of testing) NOTES:

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WILLINGNESS QUESTIONNAIRE TO BE COMPLETED BY POLICE OFFICER APPLICANTS ONLY

FULL LEGAL NAME:

TODAY’S DATE:

Please complete the following questions concerning the Police Officer position for which you are applying: Yes or No 1.

Are you willing to stand in the middle of a busy intersection directing traffic, wearing a helmet in 110 degree weather?

2.

Are you willing to physically examine a dead body for signs of injury?

3.

Are you willing to work or legal holidays (i.e. Christmas Day, Thanksgiving, July 4th)?

4.

Are you willing to work on rotating shifts with days off?

5.

Are you willing to report for duty upon short notice or on days off – sacrificing personal plans?

6.

Are you willing to investigate accidents in the rain, snow, sand storm, etc.?

7.

Are you willing to arrest a friend if it is necessary?

8.

Are you willing to spend hours writing reports while on overtime?

9.

Are you willing to work 13 hours in a row if necessary?

10.

Are you willing to handle situations that involve the possibility of injury to yourself?

11.

Are you willing to accept a court decision that runs contrary to your own wishes?

12.

Are you willing to subject yourself to intense public scrutiny and criticism?

13.

Are you willing to accept being told exactly what to do?

14.

Are you willing to maintain your composure while being insulted or sworn at?

15.

Are you willing to observe an autopsy if required?

16.

Are you willing to notify a citizen that a member of their immediate family has just been killed?

17.

Are you willing to investigate situations involving abused or molested children?

18.

Are you willing to undergo four (4) months of intensive training before being able to work on your own?

19.

Are you willing to take another human’s life if necessary and appropriate?

20.

Are you willing to deal with suicide victims and their families?

21.

Are you willing to search a dark building for a dangerous suspect if necessary?

22.

Are you willing to risk your life for the safety of a citizen or fellow officer?

23.

Are you willing to enforce laws that you do not agree with?

If you answered “NO” to any of the above questions, please reconsider applying for this position.

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310 Nolan Big Spring, TX 79720

Ph. (432) 264-2346 Fax (432) 264-2387

Attached is information concerning the Big Spring Police Department’s recruiting process and an application for employment as a Police Officer. Please read the enclosed information carefully before completing the application. You must meet the minimum qualifications and not meet any of the listed disqualifications. The completed application must be signed and notarized then returned in person or by mail to: CITY OF BIG SPRING HUMAN RESOURCES DEPARTMENT 310 Nolan Big Spring, TX 79720 Upon receipt, your application will be reviewed to determine if you qualify for the next step in the application process. You will be notified of this decision by mail or telephone. It is not necessary for you to contact the City of Big Spring regarding any job openings after you have completed and returned your application. If you are among the most qualified applicants for a position, an interview will be arranged.

Note: After you have completed and returned the application, you are required to inform the Human Resources Department of any changes (address, phone number, application with other departments, etc.). Failure to do so may result in disqualification of your application. APPLICANT INSTRUCTIONS Your interest in employment with the Big Spring Police Department is appreciated. In order to gain a better understanding of your background and work history, we ask that you answer all questions completely and to the best of your knowledge. Use the abbreviation “NA” if a particular provision or section in the form is not applicable to you.

Incomplete applications will not be considered. handwritten in ink by the individual applying.

The application must be

Employment decisions are made solely on the basis of qualifications to perform the work for which you are applying. Qualifications include education, training, work experience and other factors which are relevant in determining job performance. All information provided in this application will be verified through schools, former employers, licensing/certification agencies or other sources if applicable.

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APPLICANT INFORMATION Requirements Must be at least 21 years of age. Must have 20.20 vision (correctable with lenses). Must have a High School Diploma or GED Certificate with college hours as required by Texas Commission on Law Enforcement Standards and Education (TCLEOSE). Must have a valid and current Texas driver’s license or obtain one by time of employment. Disqualifications Any of the following will disqualify an applicant from further consideration at any stage of the process: ⌦ Having a conviction for, being under indictment for, or currently charged with any felony offense. ⌦ Having a conviction for or currently charged with any misdemeanor offense that would be considered as one involving moral turpitude. ⌦ Having a conviction for Driving Under the Influence (DUI or DWI). ⌦ Currently being on probation for any offense. ⌦ Inability to comply with Texas Commission on Law Enforcement Officer Standards and Education (TCLEOSE) requirements. For all of the above, a person is convicted of an offense when a court of competent jurisdiction enters an adjudication of guilt on the offense against the person whether or not: • • •

the sentence is subsequently probated and the person is discharged from probation including deferred adjudication; the accusation, complaint, information or indictment against the person is dismissed and the person is dismissed and released from all penalties and disabilities resulting from the offense; or the person is pardoned for the offense, unless the pardon is expressly granted for subsequent proof of innocence.

⌦ Having habitually used excessive amounts of alcoholic beverages in the past. ⌦ Having illegally used marijuana within three (3) years preceding the written examination. Any previous use of a powder or liquid controlled substance is prohibited. ⌦ Having illegally used any controlled substance or dangerous drug to the extent beyond “experimental”. ⌦ Having illegally furnished any controlled substance or dangerous drug to another person. ⌦ Having an excessive record of traffic convictions or negligent traffic collisions as defined in the City of Big Spring Personnel Policies and Procedures. ⌦ Not being of good moral character; or being known to habitually associate with those of questionable moral character. ⌦ Having a series of delinquent payments or not meeting financial obligations or repeated occurrences of issuing checks without sufficient funds, when there are no extenuating circumstances present to explain the situation. ⌦ Having been discharged from military service with a dishonorable discharge or having been convicted of any offense tries before a general court martial (discharge must meet TCLEOSE standards). ⌦ Being a member of any organization, that advocates the overthrow of the government by force or violence. ⌦ Having been discharged from any commissioned or recruit position within a law enforcement agency for disciplinary reasons, resigning to avoid suspension or discharge or having resigned during a disciplinary investigation without a final judgment having been rendered. 9

⌦ Failing to cooperate fully with and keep all scheduled appointments with staff personnel involved in the selection process. Failing to provide added personal information as needed or failing to submit information within 15 days of the change. Refusal to submit, if requested, to a polygraph exam to resolve any conflict(s) that may arise during the background investigation. ⌦ Making any false statement of fact, being deceptive by statement or omission in the written application or by any means in any part of the selection process. ⌦ Where evidence exists to indicate that in any official matter or in any significant business transaction the applicant has made false statements, falsely sworn to statements or in any other manner falsified testimony. ⌦ Without being specifically enumerated in the above disqualifications, if circumstances exist that indicate the applicant is clearly unsuited for a career with the Big Spring Police Department; the application will be rejected. The Chief of Police or his designee will make all interpretations regarding these requirements. APPLICANT PROCESS The following is an outline of the hiring process. Each stage must be successfully completed before proceeding to the next step. Preliminary Application To be considered for employment with the Big Spring Police Department, a candidate must complete the preliminary application. The application must contain truthful and complete responses. “NA” or “None” must be written in each blank that does not apply. The applications must be printed. Written Examination Applicants will be notified by mail or telephone if they are to progress to the written examination. The written examination is designed to test the relative skills and capacity of each applicant. Applicants who pass the written examination are required to complete the following two procedures as scheduled: Physical Agility Test and Oral Interview Oral Interview Applicants who successfully complete the physical agility test will be required to appear before a panel of department staff for interview. The interview will cover information learned about the applicant during the previous stages. The applicant will be asked questions designed to demonstrate certain knowledge, skills and abilities considered basic for effective performance as a police officer with the Big Spring Police Department. Personal History Questionnaire Applicants who pass all of the above stages will be given a Personal History Questionnaire. This document must be completed, notarized and returned to the Human Resources Department within the time frame established by that department. Each applicant is also required to sign an “Agreement Authorizing Release of Information”. Background Investigation A thorough background investigation is conducted to establish evidence of good moral character, a well-adjusted personality and a pattern of conduct acceptable to the Big Spring Police Department. Polygraph Polygraphs are performed on all candidates to ensure truthfulness. 10

Applicants who pass the above will receive a conditional offer of employment and continue the next stages. Psychological Review Applicants who pass the oral interview will be scheduled for a psychological review. The review is designed to assess the candidate’s mental and emotional fitness to function successfully as a Big Spring Police Officer. Medical Assessment Upon successful completion of the drug screen (a negative result), a prospective employee will complete a Medical History and Mobility Evaluation form and will be examined by a designated physician. The physician will assess each candidate’s physical condition to ensure he/she can function safely as a Big Spring Police Officer. Prospective police officers that pass the medical assessment will receive final offers of employment depending on the number of open positions. Firearms Applicants who successfully complete the background investigation stage will be required to pass a course established by department guidelines with a score of eighty percent (80%).

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POLICE EMPLOYMENT APPLICATION City of Big Spring / 310 Nolan, Big Spring, Texas 79720 PHONE: (432) 264 - 2346 FAX: (432) 264 - 2387 The City of Big Spring is an Equal Opportunity Employer and encourages applications from eligible and qualified persons regardless of race, color, religion, sex, age, national origin or physical disability. Your interest in employment with the City of Big Spring is appreciated. In order to gain a better understanding of your background and work history, we ask that you answer all questions completely in your own handwriting and to the best of your knowledge. Information provided is subject to verification. Incomplete applications will not be considered.

POSITION APPLYING FOR: _____________________________________________DATE:______________ PERSONAL INFORMATION Last Name

First

Middle

Street Address

Social Security #

City Phone Are you at least 21 years of age?

State

ZIP

Alternate Phone: YES

Email:

NO

Are you legally eligible for employment in the United States?

YES

NO

Do you work for or have you ever worked for the City of Big Spring before? YES held:

NO

If yes, please give dates and positions

Are you related by blood or marriage to any City Council member or employee of the City of Big Spring? YES whom?

NO

If yes,

Name________________________________________ Relationship________________________ Department________________________ Name________________________________________ Relationship________________________ Department________________________ Have you ever been discharged from the Armed Forces under other than honorable circumstances? (You must attach a copy of your DD 214 long form) YES NO If yes, please explain: Have you ever been convicted of, plead guilty to, received deferred adjudication, or any form of court supervision for any criminal offense (misdemeanors and felonies) other than minor traffic violations within the last ten (10) years? YES NO If yes, please explain:

NOTE: Prior to employment, applicant will be investigated for prior convictions of criminal offenses. A prior conviction will not automatically disqualify an applicant for employment but will be considered only as it relates to the job under consideration. EMPLOYMENT DESIRED Check all types of work that you will accept:

FULL TIME DAYS

PART TIME NIGHTS

TEMPORARY

SHIFTS

When are you available to begin work? ________________________ Have you read and do you understand the requirements of the job for which you have applied?

YES

NO

Can you perform the essential functions of this job with or without a reasonable accommodation?

YES

NO

All City of Big Spring employees must live within a thirty (30) commute to their workstation. This provision must be met by the end of the employees six (6) month probationary period. Does this pose a problem to you? YES NO

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EDUCATION, TRAINING, AND SKILLS Do you have a high school diploma?

YES

NO

Do you have a GED?

Diploma or GED certificate received from ________________________________

YES

NO

City and State______________________________

College, Post Graduate, Technical, or Vocational School: Location Address, City, State

Name

Course of Study

Describe any other specialized training, apprenticeships, professional licenses:

List any other skills related to the job for which you are applying:

Do you have a valid Texas driver’s license? YES Type of License:

Operators

NO

License # _____________________________

Class A CDL

Class B CDL

Has your driver’s license ever been suspended or revoked? YES

NO

13

Class C CDL

If yes, please explain:

Years Completed

Degree Received

EMPLOYMENT HISTORY Beginning with the most recent, list all employment. ALL APPLICABLE BLANKS MUST BE COMLETED. Resumes may not be submitted in place of employment history, but may be attached as a supplement to your application.

If any employment was under a different name, indicate name: ___________________________________________

Employer

Phone

(

Position Held

Employment Dates

)

Address City, State Type of Business May we contact this employer?

Salary

$

Salary

$

Supervisor YES

NO

Brief descriptions of duties:

Reason for leaving:

Employer

Phone

Position Held

Employment Dates

Address City, State Type of Business May we contact this employer?

Supervisor YES

NO

Brief descriptions of duties:

Reason for leaving:

14

(

)

Employer

Phone

(

Position Held

Employment Dates

)

Address City, State Type of Business May we contact this employer?

Salary

$

Salary

$

Supervisor YES

NO

Brief descriptions of duties:

Reason for leaving:

Employer

Phone

(

Position Held

Employment Dates

)

Address City, State Type of Business May we contact this employer?

Supervisor YES

NO

Brief descriptions of duties:

Reason for leaving:

Please explain any periods of unemployment:

Have you been discharged or asked to resign from a job in the last five (5) years? YES

15

NO

If yes, please explain:

PERSONAL REFERENCES List three people whom you have known for at least three years – do not include relatives or former employers.

Full Name

Relationship

Address

Phone

How long have you known this person?

Occupation

Full Name

Relationship

Address

(

)

Phone

(

)

How long have you known this person?

Alt. Phone

(

)

Full Name

Relationship

Address

Phone

(

)

How long have you known this person?

Alt. Phone

(

)

OTHER How did you learn of this job opening? (Check one) Newspaper Ad

Which Newspaper? __________________________________________________

Workforce Commission

City of Big Spring Website

City Employee

Walk In

Other

_________________________

PLEASE READ CAREFULLY BEFORE SIGNING Hereby certify that all information given on this application is true, correct, and complete to the best of my knowledge. I understand that discovery of misrepresentation or omission of facts herein will make me ineligible for employment and is cause for immediate dismissal. I hereby authorize any corporation, former employer, educational institutions, law enforcement agencies, city, county, state, and federal courts and military services to release information about my background including, but not limited to, information about employment, education, criminal record, driving record and general reputation. I agree to furnish any additional information required to complete the background check. I release all relevant parties from all liability resulting from furnishing such information. I indemnify the City of Big Spring against any liability which may result from making such inquiries. I also understand that employment with the City of Big Spring is contingent upon the results of an employment physical and drug alcohol screen. I further understand that this is an application for employment and that no employment contract, whether express or implied, is being offered. I also understand that, if employed, such employment is for no fixed or definite period and is subject to change in wages, conditions, benefits and operating policies. Any employment is “at will” and may be terminated at any time, with or without notice. __________________________________________________ Signature of Applicant

_____________ Date

Subscribed and sworn to before me, by said ___________________________________________, this ______ day of________, 20____ to certify which witness my hand and seal of office.

____________________________________________ Notary Public

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DRUG AND ALCOHOL POLICY APPLICANT’S OVERVIEW FORM The City of Big Spring has a commitment to a drug-free workplace as a leader in promoting a drug-free work force.

All applicants, upon a conditional offer of employment for regular full or part-time positions and temporary positions, will be required to submit a urine sample for the purpose of a drug screen. A job applicant who refuses to consent to a drug and alcohol test, fails to report to the collection site, or fails (tests positive) for such test will be denied employment for at least two (2) full years. If a sample is positive the applicant will be given the opportunity to report any medications that have been recently used to the Medical Review Officer (MRO). A positive test result will be confirmed by a second test using a gas chromatography/mass spectrometry (GC/MS) test, using a portion of the same sample. The Human Resource Director will notify by telephone and in writing applicants who are disqualified based upon a positive test result. Applicants may appeal the disqualification by submitting a written statement to the Human Resource Department within seventytwo (72) hours from first notification of disqualification, and providing the necessary funds to complete the second (2nd) test. If the second (2nd) test is negative the City will reimburse the applicant. All employees are subject to a Drug and Alcohol Policy depending upon their jobs, which may include testing under the following conditions: post-vehicle accident, postincident, reasonable suspicion, random and firearm discharge. I certify that I have read the above overview of the City of Big Spring Drug and Alcohol Policy and consent to comply with all provisions of the policy.

Social Security Number Printed Name Signature Date

Revised 10/01/06

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PRE-EMPLOYMENT PSYCHOLOGICAL EVALUATION WAIVER OF CONFIDENTIALITY I understand that after a conditional offer of employment has been made for a Police Officer, Communications Officer, or Jailer with the City of Big Spring, I will be examined by a physician or qualified psychologist and be found to be free of any emotional or mental condition which might adversely affect my ability as a Police Officer, Communications Officer, or Jailer. Such examination or examinations will include, but not necessarily be limited to, the Minnesota Multiple Personality Inventory (MMPI) and not less than one clinical interview session with the physician or qualified psychologist. I further understand that the results of my psychological examination or examinations will be reviewed by personnel of the City of Big Spring for determination of the suitability of my mental or emotional condition for Police Officer, Communication Officer, or Jailer duties with or without reasonable accommodation with the American’s with Disabilities Act (ADA). Therefore, I waive any privilege of confidentiality of “physician-patient relationship,” or psychotherapist-patient relationship,” to the extent that the results of the examination herein before described may now or at any future time be released to the City of Big Spring, its officers, agents or assigns, for the purpose of assessing my emotional and mental suitability for detention officer duties and authorize such physicians, psychologists, their agents or employees, to release such records.

Dated this of Texas.

day of

, 20

, in the County of Howard, State

Printed name of person giving consent

Signature of the person giving consent 18

APPLICANT EEO DATA FORM The information requested is optional and is being collected for the purpose of reporting to Federal and Equal Employment Opportunity Agencies and will not be considered as part of the application for employment. It will be separated from the application. 1. Position Applying

2. Social Security No.

3. Last Name (Type or Print)

First

Middle

4. Address

City

State

5. Home Phone

6. Work Phone

7. Sex

ZIP Code

8. Birth Date 9. Ethnic Origin (Check mark preferred)

__ Male __ Female

__ White

__ Black

10.Veteran

11. Spouse of Veteran

__ Hispanic

Asian/Pac.

Am.Ind/

__ Islander

__ Alaskan

__ Other

12. Orphan of Veteran

__ Yes

__ Yes

__ Yes

__ No

__ No

__ No

13. How did you find out about this job? __ Other City Employee

__Newspaper

__WorkIn Texas.com

__Job Fair

__College/University Career Day

__Other (specify)

__Presentation Publication

__Human Resource/Personnel Officer

__Recruitment Poster

__Radio

__Television

__City Web Site - Internet

Signature-Applicant

Date

White (Not of Hispanic origin) - All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East. Black (Not of Hispanic origin) - All persons having origins in any of the Black racial groups of Africa. Hispanic - All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. Asian or Pacific Islander - All persons having origins in any of the original peoples of the Far East, SoutheastAsia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example China, India, Japan, Korea, the Phillippine Islands, and Samoa. American Indian or Alaskan Native - All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.

An Equal Opportunity Employer

19

Human Resource Dept. City of Big Spring 310 Nolan Big Spring, TX 79720 (432) 264-2345

AGREEMENT AUTHORIZING RELEASE OF INFORMATION TO WHOM IT MAY CONCERN: I, , am an applicant for a position with the City of Big Spring Police Department. The City of Big Spring needs to thoroughly investigate my employment background and personal history to evaluate my qualifications to hold the position for which I applied. It is in my and the public’s interest that all relevant information concerning my personal and employment history is disclosed to the above department, (except for information covered by the Americans Disabilities Act, “ADA”). I hereby authorize any representative of the City of Big Spring bearing the release to obtain any information in your files pertaining to my employment records and I hereby direct you to release such information upon request of the bearer. I do hereby authorize a review of and full disclosure of all records, or any part there of, concerning myself, by and to any duly authorized agent of the City of Big Spring, whether said records are of public, private, or confidential nature. The intent of this authorization is to give my consent for full and complete disclosure. I reiterate and emphasize that the intent of this authorization is to provide full and free access to the background and history of my personal life, for the specific purpose of pursuing a background investigation that may provide pertinent data for the City of Big Spring to consider in determining my suitability for employment with that City. It is my specific intent to provide access to personal information, however personal or confidential it may appear to be. I consent to your release of any and all public and private information that you may have pertained to me, my work background and reputation, my military service records, educational records, my criminal history record, including any arrest records, any information contained in investigatory files, efficiency ratings, complaints or grievances filed by or against me, the records or recollections of attorneys at law, or other counsel, whether representing me or another person in any case, either criminal or civil, in which I presently have or have had an interest, attendance records, polygraph examinations, and any internal affairs investigations and discipline, including any files which are deemed to be confidential, and/or sealed.

Applicants Initials

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I hereby release you, your organization, and all others from liability or damages that may result from furnishing the information requested, including any liability or damage pursuant to any state or federal laws. I hereby release you as the custodian of such records of the City of Big Spring, including its officers, employees, and other related personnel, both individually and collectively, from any and all liability for damages of whatever kind, which may at any time result to me, my heirs, family, or my associates because of compliance with this authorization and request to release information, or any attempt to comply with it. I direct you to release such information upon request of the duly accredited representative of the City of Big Spring regardless of any agreement I may have made with you previously to the contrary. The Personal Representative requesting the information pursuant to this release will discontinue processing my application if you refuse to disclose the information requested. For and in consideration of the City of Big Spring’s acceptance and processing of my application for employment, I agree to hold the City of Big Spring, its agents and employees harmless from any and all claims and liability associated with my application for employment or in any way connected with the decision whether or not to employ me with the City of Big Spring. I understand that should information of a serious criminal nature surface as a result of this investigation, any such information may be turned over to the proper authorities. I understand my rights under Title 5, United States Code, Section 552a, the Privacy Act of 1974, with regard to access to disclosure of records, and I waive those rights with the understanding that information furnished will be used by the City of Big Spring in conjunction with employment procedures. I further agree that I shall not have the right to read or otherwise review any information received by the City of Big Spring as a result of inquiries pursuant to this Agreement Authorizing Release of Information. A photocopy of FAX copy of this release form will be valid as an original thereof, even though the said photocopy or FAX copy does not contain an original writing or my signature. This waiver is valid for a period of twelve (12) months from the date of my signature. Should there be any questions as to the validity of this release, you may contact me at the address listed on this form. I agree to indemnify and hold harmless the person to who this request is presented and his employer, agents, and employees from and against all claims, damages, losses and expenses, including reasonable attorney fees, arising out of or by reason of complying with this request.

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THIS SECTION TO BE COMPLETED IN THE PRESENCE OF A NOTARY:

Printed Name of Person Giving Request

Signature

Date of Birth

Current Address

City

State

( ) Primary Phone #

Zip Code ( ) Secondary Phone #

STATE OF TEXAS COUNTY OF HOWARD SUBSCRIBED AND SWORN TO before me this____day of by .

_, 20 ,

Notary Public My Commission Expires: 22

THE CITY OF BIG SPRING POLICE DEPARTMENT

PERSONAL HISTORY QUESTIONNAIRE Based on the detailed personal information contained in this questionnaire, we are including it in our envelope for your completion. However, do not submit this questionnaire with the application packet. The background officer, upon your successful completion and passing of the following, will request it: 1. Completed application 2. Motor Vehicle/Drivers’ License check and Criminal History Upon successful completion of the above items, you are eligible to test for Police Officer vacancy. You will receive a phone call, and be scheduled for the following steps. 3. Written test, upon scoring a passing grade 4. Physical agility test, upon successful completion 5. Oral boards At this time, a detailed background and personal history will be conducted and you will be requested to submit this Personal History Questionnaire. WARNING!! This is not part of the application packet. This questionnaire is desired to obtain relevant information of your character and other related history to ensure the safety of the public and to provide the legal system (the Courts) with Police Officer’s qualified to testify under oath in a Court of Law.

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PERSONAL HISTORY QUESTIONNAIRE (Please Print)

IDENTIFICATION NAME:________________________________________________________________________ Last First Middle SOCIAL SECURITY NUMBER:_____________________________

DATE OF BIRTH:_____________

NICK-NAME(S), MAIDEN NAME, OR OTHER NAMES BY WHICH YOU HAVE BEEN KNOWN:________________________________________________________________ PLACE OF BIRTH:______________________________________________________________ City ARE YOU A U.S. CITIZEN?

County [ ] YES

State

[ ] NO

DRIVER’S LICENSE #: ___________________

STATE OF ISSUE: ___________________

COLOR OF EYES: __________________

COLOR OF HAIR: ____________________

SCARS, TATTOOS OR OTHER DISTINGUISHING MARKS: _______________________________ _____________________________________________________________________________ BLOOD TYPE: ____________________ RESIDENCES: List ALL addresses where you have lived during the past 10 years, beginning with present address. List date by month and year. Attach extra page if necessary. FROM

TO

ADDRESS

____________ ____________

_______________________________________________

____________ ____________

_______________________________________________

____________ ____________

_______________________________________________

____________ ____________

_______________________________________________

____________ ____________

_______________________________________________

___________

_______________________________________________

____________

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MILITARY U.S. VETERAN? [ ] YES

[ ] NO

DATES OF SERVICE: FROM ____________TO____________ BRANCH OF SERVICE:_____________________________

MILITARY SERVICE NUMBER:_____________

WERE YOU EVER DISCIPLINED WHILE IN THE MILITARY SERVICE? (Include Court Martial, Captain’s Masts, Company Punishment, Etc.) [ ] YES [ ] NO CHARGE AGENCY __________ __________

DATE AGE AT TIME _______ _____________

DISPOSITION _______________________

__________ __________

_______ _____________

_______________________

__________ __________

_______ _____________

_______________________

__________ __________

_______ _____________

_______________________

PLEASE GIVE COMPLETE DETAILS OF YOUR MILITARY DISCHARGE:

MARITAL AND FAMILY HISTORY ARE YOU?

[ ] SINGLE

[ ] ENGAGED

[ ] MARRIED

[ ] SEPARATED

[ ] DIVORCED

[ ] WIDOWED

IF ENGAGED: NAME OF FIANCE: _____________________________________________ ADDRESS:______________________________________________________________ IF MARRIED: SPOUSE’S NAME: (with maiden name)________________________________ DATE OF MARRIAGE: ___________CITY AND STATE:_______________________ IF DIVORCED, ANNULLED, WIDOWED: DATE OF MARRIAGE: ___________CITY AND STATE: _______________________ DATE OF DIVORCE, ANNULMENT, DECEASED:____________________________ SPOUSE’S NAME (with maiden name) AND ADDRESS: ________________________ ________________________________________________________________________ COURT AND STATE OF DIVORCE, ANNULMENT:___________________________

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LIST ALL CHILDREN RELATED TO YOU OR YOUR SPOUSE: (Natural, step-children, adopted and foster children): NAME

RELATION

BIRTHDATE

ADDRESS

SUPPORTED BY

DO YOU HAVE OTHER DEPENDENTS? If so, please list:

LIST RELATIVES IN THE FOLLOWING ORDER: FATHER, MOTHER (include maiden name), BROTHERS, SISTERS (if deceased so indicate): NAME

ADDRESS & PHONE #

RELATION

AGE

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FINANCIAL HISTORY SOURCES OF INCOME: _________________________________________________ ________________________________________________________________________ WHAT IS YOUR PRESENT SALARY OR WAGE?:____________________________ DO YOU HAVE ANY INCOME FROM ANY SOURCES OTHER THAN YOUR PRINCIPAL OCCUPATION? [ ] YES

[ ] NO

IF YES, HOW MUCH? ______________________ HOW OFTEN?_________________ THE SOURCE? __________________________________________________________ DO YOU HAVE ANY REAL ESTATE? [ ] YES

[ ] NO

VALUE $________________ LOCATION __________________________________ DO YOU OWN ANY CORPORATE STOCK? [ ] YES [ ] NO

VALUE $_________

DO YOU HAVE A BANK ACCOUNT? [ ] YES [ ] NO SAVINGS – AVERAGE BALANCE $________________________________________ NAME AND ADDRESS OF BANK: _________________________________________ CHECKING – AVERAGE BALANCE $ ______________________________________ NAME AND ADDRESS OF BANK: _________________________________________ FINANCIAL OBLIGATIONS: Give name and addresses of the individuals, companies or others to whom you are indebted and the extent of your debt. Include rent, mortgages, vehicle payments, charge accounts, credit cards, loans, child support payments, and any other debts and payments, include account numbers where applicable. Continue on separate sheet if needed. CREDITOR NAME

REASON FOR DEBT

MONTHLY PMT.

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ORGANIZATIONS LIST ALL ORGANIZATIONS YOU ARE CURRENT AND PAST, YOU ARE OR HAVE BEEN A MEMBER OF (i.e.: Social, Fraternal, Professional, etc.): NAME

ADDRESS

TYPE

FROM

TO

PERSONAL DECLARATIONS IF IT BECOMES NECESSARY TO TAKE HUMAN LIFE IN THE COURSE OF YOUR DUTIES AS A POLICE OFFICER, WOULD ANY BELIEFS PREVENT YOU FROM DOING SO?

[ ] YES

[ ] NO

IF YES, PLEASE EXPLAIN: _______________________________________________ ________________________________________________________________________ ________________________________________________________________________ I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statements and answers to questions. I am fully aware that any such willful misrepresentations, omissions, or falsifications may be grounds for immediate rejection or termination of employment. ____________________________________ Signature of Applicant Date:___________________________ Subscribed and sworn to before me, by the said _________________________________ this the ___________ day of _____________________, 200__ to certify which witness my hand and seal of office. ____________________________________ Notary Public in and for the State of Texas My Commission expires:_______________

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