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5 Police Officer July 2020

Steps

1. Personal Information This section is complete This section is incomplete
2. Position Information This section is complete This section is incomplete
3. Education/Training This section is complete This section is incomplete
4. Background Information This section is complete This section is incomplete
5. Military Service This section is complete This section is incomplete
6. Employment History This section is complete This section is incomplete
7. References This section is complete This section is incomplete
8. Attachments This section is complete This section is incomplete
9. Applicant Statement This section is complete This section is incomplete

Personal Information

Thank you for the interest in employment with the City of Hays, KS. The City of Hays is an Equal Opportunity Employer and we consider applicants for all jobs without regards to race, sex, disability, religion, age, color, national origin, or ancestry, or any other legally protected status.

Please complete the application completely and accurately.
Process
Attachment
Notes by HR
First Name*
Middle Name
Last Name*
Prefered Name (If different than your first name.)
Address*
Apartment Number
City*
State*
Zip*
Phone Number*
Email Address*
Driver's License Number*
Driver's License State*
Preferred Method of Communications*
Who is your cell phone provider? (Required for Text)*
Are you or will you be 21 years old within the next 6 months?*
Have you ever been convicted of a felony?*
Are you related to anyone currently working for the City of Hays?*
If so, who and what is the relationship?*
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Position Information

Position Information
Type of Employment Desired*
How did you hear about the open position?*
Who did you hear about the position from?*
Explain Other:*
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Education/Training

Education/Training
High School*
City*
State*
College
City
State
College
City
State
Highest Education you Completed
Area of Study
Other Education
Other Specialized or Technical Training Not Listed Previously. (Including any medical, weapons, self-defense, or law enforcement training.)
License, Certifications, and Registrations Not Listed Previously (Please list CDL if you have a Valid CDL)
List Other Skills, Abilities, or Qualifications relevant to this job. (Include other languages that you can speak other than English and any equipment and software you can operate.)
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Background Information

Background Information
Date of Birth:*
Birthplace:*
Are you a U.S. Citizen?*
Have you ever been arrested or charged with a crime?*
Have you ever been convicted, been placed on diversion or do you have any expunged convictions, for any crime?*
Have you ever been convicted or placed on diversion for any crime of domestic violence?
Have you in the past or are you currently involved in civil litigation?*
Have you ever been terminated or asked to resign from a job?*
Explanation of arrest or convictions (if any):*
Explanation of civil litigation occurrence (if any):*
List the RESIDENCES you have lived in over the last ten years. Include the Address, City, State, and Dates.*
List any TRAFFIC CITATIONS you have received. Include the Date, City or Agency, and Violation.*
Why are you interested in a career in public safety?*
If the local media conducted a "background" check in order to discredit your candidacy for this position, what would they find? Please explain potentially negative things in your background.*
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Military Service

Military Service
Have you ever been or are you currently a member of the United States Armed Forces?
Branch of Service*
Unit*
Commanding Officer*
Mailing Address*
Entry Date*
Separation Date*
Highest Rank Attained:*
Type of Discharge:*
Other Military Information:
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Employment History

Employment History - Start with your most recent job.
Company*
Position*
City*
State*
Phone Number*
Supervisor*
May we contact your previous supervisor for a reference?*
State Date*
End Date*
Last Salary*
Reason for Leaving/Looking to Leave*
Responsibilities*
Do you have another employment to enter?*
Company*
Position*
City*
State*
Phone Number
Supervisor
May we contact your previous supervisor for a reference?*
Start Date*
End Date*
Last Salary*
Reason for Leaving/Looking to Leave*
Responsibilities*
Do you have another employment to enter?*
Company*
Position*
City*
State*
Phone Number
Supervisor
May we contact your previous supervisor for a reference?*
Start Date*
End Date*
Last Salary*
Reason for Leaving/Looking to Leave*
Responsibilities*
Do you have another employment to enter?*
Company*
Position*
City*
State*
Phone Number
Supervisor
May we contact your previous supervisor for a reference?*
Start Date*
End Date*
Last Salary*
Reason for Leaving/Looking to Leave*
Responsibilities*
Do you have another employment to enter?*
Company*
Position*
City*
State*
Phone Number
Supervisor
May we contact your previous supervisor for a reference?*
State Date*
End Date*
Last Salary*
Reason for Leaving/Looking to Leave*
Responsibilities*
Do you have another employment to enter?*
Company*
Position*
City*
State*
Phone Number
Supervisor
May we contact your previous supervisor for a reference?*
Start Date*
End Date*
Last Salary
Reason for Leaving/Looking to Leave*
Responsibilities*
Do you have another employment to enter?*
Company*
Position*
City*
State*
Phone Number
Supervisor
May we contact your previous supervisor for a reference?*
Start Date*
End Date*
Last Salary
Reason for Leaving/Looking to Leave*
Responsibilities *
Do you have another employment to enter?*
Company*
Position*
City*
State*
Phone Number
Supervisor
May we contact your previous supervisor for a reference?*
Start Date*
End Date*
Last Salary
Reason for Leaving/Looking to Leave*
Responsibilities *
Do you have another employment to enter?*
Company*
Position*
City*
State*
Phone Number
Supervisor
May we contact your previous supervisor for a reference?*
Start Date*
End Date*
Last Salary
Reason for Leaving/Looking to Leave*
Responsibilities *
Do you have another employment to enter?*
Company*
Position*
City*
State*
Phone Number
Supervisor
May we contact your previous supervisor for a reference?*
Start Date*
End Date*
Last Salary
Reason for Leaving/Looking to Leave*
Responsibilities *
Do you have another employment to enter?*
List any additional employment history you may have. Include company, position, dates, and responsibilities.
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References

References - Please list three professional references.
Full Name*
Relationship*
Explain Other:*
Company*
Phone Number*
Full Name*
Relationship*
Explain Other:*
Company*
Phone Number*
Full Name*
Relationship*
Explain Other:*
Company*
Phone Number*
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Attachments

If you would like, you may attach additional information including Cover Letter, Resume, Certifications, etc.
Attachment
Attachment
Attachment
Attachment
Attachment
Attachment
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Applicant Statement

Applicant Statement
By submitting your application for any position with the City of Hays, you understand and agree to the following statements:
You represent and warrant that the contents of the application are true and correct and that no pertinent information has been omitted.
You authorize investigation of any or all statements on the application including but not limited to: educational background, employment and personal references, reputation, criminal record, motor vehicle department records, employment history, financial and credit history, and military service. You agree to hold harmless any employer, acquaintance, or reference for any information provided to the City of Hays. Falsification, misrepresentation or omission of information could be just cause for dismissal at any time.
You authorize investigation of any or all statements on the application including but not limited to: educational background, employment and personal references, reputation, criminal record, motor vehicle department records, employment history, financial and credit history, and military service. You agree to hold harmless any employer, acquaintance, or reference for any information provided to the City of Hays. Falsification, misrepresentation or omission of information could be just cause for dismissal at any time.
You understand that you may be required to take relevant employment testing for the purpose of determining your capability of performing the duties of the position. In the event you need reasonable accommodation for this testing, or for the interview process, if selected, you understand that the City of Hays will make this accommodation. The City of Hays reserves the right to require medical documentation concerning the need for the accommodation.
You understand that you may be required to take relevant employment testing for the purpose of determining your capability of performing the duties of the position. In the event you need reasonable accommodation for this testing, or for the interview process, if selected, you understand that the City of Hays will make this accommodation. The City of Hays reserves the right to require medical documentation concerning the need for the accommodation.
The City of Hays is committed to a drug-free workplace and requires pre-employment drug screening. If you are selected for employment by the City of Hays, you agree to participate in the appropriate examinations, determined by the position, which may include a pre-employment physical examination, psychological, and physical endurance examinations. These examinations will be paid for entirely by the City of Hays. Costs of transportation and time involved taking the examinations are the responsibility of the applicant.
The City of Hays is committed to a drug-free workplace and requires pre-employment drug screening. If you are selected for employment by the City of Hays, you agree to participate in the appropriate examinations, determined by the position, which may include a pre-employment physical examination, psychological, and physical endurance examinations. These examinations will be paid for entirely by the City of Hays. Costs of transportation and time involved taking the examinations are the responsibility of the applicant.
The City of Hays is committed to a drug-free workplace and requires pre-employment drug screening. If you are selected for employment by the City of Hays, you agree to participate in the appropriate examinations, determined by the position, which may include a pre-employment physical examination, psychological, and physical endurance examinations. These examinations will be paid for entirely by the City of Hays. Costs of transportation and time involved taking the examinations are the responsibility of the applicant.
The City of Hays is committed to a drug-free workplace and requires pre-employment drug screening. If you are selected for employment by the City of Hays, you agree to participate in the appropriate examinations, determined by the position, which may include a pre-employment physical examination, psychological, and physical endurance examinations. These examinations will be paid for entirely by the City of Hays. Costs of transportation and time involved taking the examinations are the responsibility of the applicant.
Applicant Signature*

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5 Police Officer July 2020

Steps

Personal Information

Position Information

Education/Training

Background Information

Military Service

Employment History

References

Attachments

Applicant Statement

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