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City of Sacramento
Employment Application for Reserve
Police Officer.
Sacramento Police Department
Reserve Operations
5303 Franklin Blvd.,
Sacramento, CA 95820
Telephone: (916) 277-6170
An Equal Opportunity/Affirmative
Action Employer.
INSTRUCTIONS: This
application is part of the examination process. It must be completely
filled out and signed to be accepted. THE
INFORMATION PROVIDED ON THIS PAGE WILL DETERMINE IF YOU MEET THE QUALIFICATIONS
FOR RESERVE POLICE OFFICER. Incomplete applications will
be rejected.
PLEASE PRINT OR TYPE
H.R. Use Only
___ Accepted ___ Rejected
___Education ___ Other
SOCIAL SECURITY NUMBER:
___________ - ____________-___________
Name:____________________________________________________________________________________
Last
First
Middle Initial
MAILING ADDRESS:_______________________________________________________________________
Street #
Street Name
Apartment #
___________________________________________________________________________________________________________________________
City
State
Zip Code
HOME PHONE:
( ) _______________________
OTHER
PHONE: (
)__________________________
_________________________________________________________________________________________
AGE: I am
at least 18 years of age as required on the current announcement for Reserve
Police Officer. ___YES___NO
If you answered "NO" to
this question, you are disqualified from employment as a Reserve Police
Officer at this time.
____________________________________________________________________________________________________________________________
CALIFORNIA DRIVER'S LICENSE:
Do you have one?
_____YES _____NO
Dr. License # ____________________
Class ___________ Expires _______________
If you do not have a California
Class C driver license, one will be required before you may be appointed
to Reserve Police Officer. ____________________________________________________________________________________________________________________________
CONVICTIONS: Have you
been convicted of a felony?
______YES _____NO
If you answered "YES"
to this question, you are disqualified from employment as a Reserve Police
Officer. ____________________________________________________________________________________________________________________________
EDUCATION: you have
a high school diploma or G.E.D.
______ YES ______ NO
________________________________________________________________________________________
TRAINING:
Have you successfully completed one of the following modules or basic academy:
____YES____ NO
Check one: Reserve
Training: ____Level I ____Level II ____Level III ____Mod-C/D
or ____ Basic Academy Graduate
If you answered 'NO",
you must meet the above education and training standard prior to appointment
as a Reserve Police Officer.
_____________________________________________________________________________
CITIZENSHIP:
1. Are you a
citizen of the United States?..................................................
..... ____ YES ____NO
2. If you answered
"NO" to # 1: Are you a permanent resident alien?.......
..... ____ YES ____NO
Have you applied for U.S. citizenship?..............................................
....... ____ YES ____NO
When did you apply for U.S. citizenship?
MONTH_________ YEAR _______ ___________________________________________________________________________________________________________________________
SUBSTANCE USAGE:
Have you used a felony drug
as an adult (18 yrs. and older)? ____YES _____NO
(Marijuana is not a felony drug)
If you answered "YES"
to the above question, you are disqualified from employment as a Reserve
Police Officer
with the City of Sacramento.
TO QUALIFY IN THIS RECRUITMENT,
YOU MUST SIGN AND DATE THE FOLLOWING STATEMENT:
I certify that the above
statement relating to substance usage is correct. I also realize that if
I am successful in the examination process, my background, polygraph, and
drug screening must be consistent with this statement. If I have not been
truthful or if after the date of signing this form I use an illegal drug,
including marijuana, my name will be removed from the Reserve Police Officer
eligible list.
SIGNATURE:______________________________________________
DATE:_________________________
___________________________________________________________________________________________________________________________
I certify that all statements
on this application are true and correct. I agree and understand that any
misstatements or omissions of material facts will
cause my forfeiture of all eligibility for employment with the City of
Sacramento. I understand that if I do not meet the announced requirements,I
will be eliminated from the examination process.
SIGNATURE:______________________________________________
DATE:_________________________
(Required for application to be complete)
_____________________________________________________________________________
EMPLOYMENT QUESTIONNAIRE:
Please
complete this form and submit it with your application. The completed form
is confidential and will be detached from your application. This information
is voluntary and is gathered in accordance with State and Federal laws
for the purpose of evaluating the effectiveness of our affirmative action
and recruitment efforts.
CHECK MALE OR FEMALE
____ Male ____ Female
ALSO, PLEASE CHECK ONLY
ONE BOX FOR THE RACIAL/ETHNIC CATEGORY YOU MOST CLOSELY IDENTIFY WITH.
(SEE
BELOW FOR THE ETHNIC DEFINITIONS.)
____ 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, regardlessof
race.
____Asian or Pacific Islander
All persons having origins in any of the original peoples of the Far East,
Southeast Asia, the Indian
Subcontinent, or the Pacific Islands (for example, China, Japan, Korea,
and Samoa). (Excluding the
Phillippine Pacific Islander Islands).
____American Indian or Alaskan
Native
All persons having origins in any of the original peoples of North America,
and who maintain cultural
identifications through tribal affiliation or community recognition. Please
identify your tribal
affiliation: __________________________.
____Filipino
All persons having origins in the Philippine Islands.
H:\POLICE\RESRVAPP Revised 6/10/99
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