Morris Police Department 400 Colorado Avenue P.O. Box 245 Morris, MN 56267 Phone: 320-208-6500 Fax: 320-589-1157 www.ci.morris.mn.us/pd mpd@co.stevens.mn.us APPLICATION FOR EMPLOYMENT General Information Position Applied For: Available to Work: Full Time Part Time Seasonal Date of Application: Date Available for Work: Email Address: Last Name: First Name: Middle Name: Street Address: City: State: Zip: County: Phone Number: Have you been previously employed by the city? No If yes, Date Position Are you able to legally work in the United States? No For Police Department Positions Only Are you currently Minnesota P.O.S.T. licensed or eligible for Minnesota P.O.S.T. licensing? (please select one), I am currently licensed. Please indicate license # Expiration, I am eligible for P.O.S.T. licensing with a test date of from the Minnesota P.O.S.T. Board. No, I am not licensed or not currently eligible for licensing. Educational Background Education School Name, City, State Major Area of Study High School Diploma No GED No College College Technical/Certificate Programs Degree Completed: Masters AAS Bachelors Other: Degree Completed: Masters AAS Bachelors Other: Indicate type of certificate earned:
Employment History- List your present or most recent employer FIRST. List all employment for the past 10 years (use additional sheet if necessary) PRESENT EMPLOYER Employer: Address: Dates Employed: From: To: Job Title: Telephone: Job Duties: Starting Rate: Pay Information Ending Rate: Reason For Leaving: May we contact this employer? No If no, Explain: PREVIOUS EMPLOYER Employer: Address: Dates Employed: From: To: Job Title: Telephone: Job Duties: Starting Rate: Pay Information Ending Rate: Reason For Leaving: May we contact this employer? No If no, Explain: 2 nd PREVIOUS EMPLOYER Employer: Address: Dates Employed: From: To: Job Title: Telephone: Job Duties: Starting Rate: Pay Information Ending Rate: Reason For Leaving: May we contact this employer? No If no, Explain: 2
3 rd PREVIOUS EMPLOYER Employer: Address: Dates Employed: From: To: Job Title: Telephone: Job Duties: Starting Rate: Pay Information Ending Rate: Reason For Leaving: May we contact this employer? No If no, Explain: 4 th PREVIOUS EMPLOYER Employer: Address: Dates Employed: From: To: Job Title: Telephone: Job Duties: Starting Rate: Pay Information Ending Rate: Reason For Leaving: May we contact this employer? No If no, Explain: 5 th PREVIOUS EMPLOYER Employer: Address: Dates Employed: From: To: Job Title: Telephone: Job Duties: Starting Rate: Pay Information Ending Rate: Reason For Leaving: May we contact this employer? No If no, Explain: ***Please attach sheet with additional work experience if necessary*** Explain any periods of unemployment: 3
Volunteer Experience Organization: Duties: # of Hours: From: To: Describe any additional experience or training that qualifies you for this job IMPORTANT FACTS CONCERNING INFORMATION PROVIDED ON YOUR APPLICATION You are advised that the information requested on this form will be used for the purposes of determining job qualifications, salary rates within range and for summary data purposes, and may constitute a public record according to Minnesota Statutes. You are not legally required to supply the requested information, but the information is necessary in determining your qualifications for the position for which you have applied. An incomplete application may hinder your employment with the city. All materials submitted in support of an application are normally retained with the applications and not returned. You should not submit an original document if it is your only copy. I understand that any false information on or omission of information from this application, or failure to present the required proofs, will be caused for rejection or dismissal if employed. The City of Morris is an Equal Opportunity Employer Applicants Signature Date Please be advised that in accordance with the Minnesota Uniform Transaction Act, an electronic signature on this document is binding and afforded the same effect as if the document was signed by hand. 4
PROFESSIONAL REFERENCES Name & Occupation Address Phone Number 5
CERTIFICATION & AUTHORIZATION 1) I authorize the investigation of all statements I enter on my application and certify that they are true and correct to the best of my knowledge. I understand that should investigation disclose material misrepresentation or falsification, my application may be disqualified, or if employed, my employment and all rights and privileges of my employment may be immediately terminated. 2) I understand that in order to determine my qualifications for positions I apply for it may be necessary to investigate my employment history, educational accomplishments, criminal history, and credit reports. I direct the custodian of these records to release this information to any authorized agent of the employing organization. I release any individual, institution, business or organization from any and all liability for damages which might arise from the release of pertinent information. 3) I understand that if the position I am applying for requires the operation of either employee or employer-owned motor vehicles I must maintain personal licensure appropriate to vehicle and responsibilities of the position. Further, I authorize the employer to request and obtain Drivers License Records necessary to confirm my licensure and responsible driving history. 4) I understand that if offered employment, the offer may be contingent on my passing a pre-employment substance-abuse screen, a pre-employment medical/health examination, and a psychological examination. I voluntarily agree to submit to a preemployment substance abuse screen and/or medical/health examination on request. I understand that failure to pass required substance abuse screens or medical/health examination may result in withdrawal of offer. I have read, understand, and agree to, the above statements. Signed: Date: Please be advised that in accordance with the Minnesota Uniform Transaction Act, an electronic signature on this document is binding and afforded the same effect as if the document was signed by hand. 6
TENNESSEN WARNING In accordance with the Minnesota Government Data Practices Act, the City of Morris is required to inform you of your rights as they relate to the private information collected from you. Private data is information that is available to you, but not the public. The personal information we collect about you is private. Minnesota Statutes 13.04 and 13.43 are two sections that govern what affects you as an applicant for employment with the City of Morris. All data collected is considered private except for the following: (1) Your veteran s status. (2) Relevant test scores. (3) Your rank on our eligibility list. (4) Your job history. (5) Your education and training. (6) Your work availability. Your name is considered private information; however, if you are selected to be interviewed as a finalist, your name becomes public information. The data supplied by you may be used for such other purposes as may be determined to be necessary in the administration of personnel policies, rules, and regulations of the City of Morris. Furnishing social security numbers, date of birth (unless a minimum age is required), sex, age group, and disability data is voluntary, but refusal to supply other requested information will mean that your application for employment may not be considered. Private data is available only to you, appropriate City employees, and others as provided by state and federal law who have a bona fide need for the data. Public data is available to anyone requesting it and consists of all data furnished in the application for employment that is not designated in this notice as private data. Except for race, sex, age, and disability data, the information you give us about yourself is needed to identify you and to assist the City of Morris s Administrator s Office in determining your suitability for the position for which you are applying. Race, sex, age, and disability data are used in summary form by the City of Morris to monitor protected class employment and to meet federal, state, and local reporting requirements. I declare that I have read and understand the information given above regarding the Minnesota Data Practices Act. Applicant s Printed Name: Applicant s Signature: Date: Please be advised that in accordance with the Minnesota Uniform Transaction Act, an electronic signature on this document is binding and afforded the same effect as if the document was signed by hand. 7
VETERAN S PREFERENCE CLAIMS FORM Preference points are awarded to qualified veterans and spouses of deceased or disabled verterans to add to their exam results. Points are awarded subject to provisions of Minnesota Statutes 43A.11. To qualify for preference, you must have served on active duty in any branch of the Armed Forces of the United States for 181 consecutive days or more, and have been honorably discharged; you must be a citizen of the United States and currently not receiving a monthly veteran s pension based exclusively on length of service. Veteran s Preference may be used by the surviving spouse of a deceased veteran and by the spouse of a disabled veteran who because of the disability is unable to qualify. The information you provide on this form will be used to determine your eligibility for veterans' points. You are not required to supply this information, but we cannot aware veteran's points without it. You must supply a copy of your DD214. Disabled veterans must also apply form FL-802 or equivalent letter from a service retirement board. Spouses applying for preference points must supply their marriage certificate, the veterans DD214 and FL-802 or death certificate. NAME: Last First Middle ADDRESS: Street City State Zip ACTIVE DUTY INFORMATION: (NOTE: Your DD214 form MUST accompany this claim form) Have you or your disabled or deceased spouse served on active military duty without interruption for 181 days or more? No Type of Separation: Honorable Medical Other Are you receiving or are you eligible to receive a monthly veteran s pension based exclusively on length of military service? No FOR DISABLED VETERANS: Percent of Disability: % Letter from V.A. in proof of disability must be submitted to receive points Permanent? No Currently Existing? No Have you ever been promoted in City Employment? No Veteran s Present Occupation: FOR SPOUSES OF DECEASED VETERANS: Date of Death: Have you remarried? No AFFIDAVIT: I hereby claim veteran s preference for this examination and certify that all information given is true, complete and correct to the best of my knowledge. Signature: Date: Please be advised that in accordance with the Minnesota Uniform Transaction Act, an electronic signature on this document is binding and afforded the same effect as if the document was signed by hand. 8
Required Supplemental Application Form Applicant Name: YOU MUST COMPLETE AND RETURN THIS FORM TO BE CONSIDERED AS AN APPLICANT. Please note: This supplemental form will be used to rank applicants, so please be complete and accurate in your responses. Please attach additional sheets if needed to complete the responses below. POLICE OFFICER 1. Police Related Skills: Please check all the boxes below that relate to your police related experience in the following areas and any other relevant information related to your experience: Patrol Experience Investigator Experience K-9, School Resource Officer Use of Force Instructor, Defensive Tactics, or Taser Military Police, Corrections, Park Ranger, or Security Guard Other: Please describe your experience and how much experience you have on the items checked above: 2. Knowledge of Policing: Please check all the boxes below related to what experiences you have had that has provided you with some additional insight on policing beyond the required education and training. Work or have worked in a police related field Completed a ride-along with a law enforcement agency, Citizen Police Academy, Explorer, Internship, or Reserve Officer Program Law enforcement or skills instructor/professor references Other: Please describe your knowledge of policing and the experiences you have in detail: 1
3. Leadership Skills: Please check all the boxes below that relate to your leadership skills. These can include work, education, or personal experiences where the following have been demonstrated. Leadership position where elected or appointed by a group of peers as a squad or team leader Assigned or appointed a position where you were the leader on an assignment or a project Volunteered for a committee or organization where you were the leader or played a lead role Other: Please describe your skills in more detail including your experiences, positions, duration, etc: 4. Communication Skills: Please check all the boxes below related to your communication skills. These can include work, education, or personal experiences where the following have been demonstrated. Speaking in front of large groups of people Communicating difficult information to others Speaking a foreign language, what language(s): Written communication (letters, reports, papers, etc.) Other: how fluent? Please describe your skills in more detail including your experiences, skill level, and proficiency: 5. Customer Service Skills: Please check the boxes below related to your customer service experience. These can include work, education, or personal experiences where the following have been demonstrated. Assisting customers one-on-one Resolving customer complaints or issues Experience handling difficult customer service issues Other: 2
Please describe your skills in more detail including your experiences, skill level, and proficiency: 6. Community Service Skills: Please check the boxes below related to your experience as it relates to community service. Assisted people in need Active member in my community on committees or organizations Actively involved in a volunteer organization Volunteer occasionally for organization in need Other: Please describe the experience and equipment used, the company, and duration: ************* I hereby certify that all answers contained in this application are true and I agree and understand that any misrepresentation or omission of facts contained in my application for employment or this addendum will be grounds for disqualification for employment, or in the event of employment, immediate dismissal from employment upon later discovery of any omission of facts or misrepresentations. I further understand that if offered a position, I must submit to and pass a controlled substance screen and will be required to submit to and pass a criminal background check, and employment reference checks. By my signature on this form, I hereby acknowledge that I have read and understood the above statements. Failure to sign application forms may result in rejection of your application. Applicant s signature: Date: Please be advised that in accordance with the Minnesota Uniform Transaction Act, an electronic signature on this document is binding and afforded the same effect as if the document was signed by hand. 3
Morris Police Officer Qualification Questionnaire 1. The following supplemental information may be used as a scored evaluation of your knowledge, skills and experience. Be certain that the choices you make correspond to the information you have provided in your application and resume. You must be honest and accurate in answering the supplemental questions and do not type see resume. You may also be asked to demonstrate your knowledge and skills in a work sample, or during an interview for this position. By completing this questionnaire, you are attesting that the information you have provided is true and accurate. Information provided may be reviewed by the hiring manager. Any misstatements or falsification of information will eliminate you from consideration or may result in dismissal. Do you understand and agree with this statement? No 2. Have you ever been denied employment in a law enforcement related position based on the findings of a background investigation? No 3. MN STAT 626.87 and MN RULES 6700.0700 preclude certain individuals from licensure if convicted of any felony as an adult. Have you been convicted of a felony since you became 18 years old? No 4. MN STAT 626.87 and MN RULES 6700.0700 precludes certain individuals from licensure if convicted for any of the following crimes. Please indicate if you have been convicted of any of the following. (Select all that apply). 609.224 Assault in the fifth degree 609.2242 Domestic Assault 609.231 Mistreatment of residents or patients 609.2325 Criminal Abuse (vulnerable adult) 609.233 Criminal Neglect (vulnerable adult) 609.2335 Financial Exploitation (vulnerable adult) Not Applicable
5. Have you been convicted under any state or federal narcotics or controlled substance law irrespective of any proceeding under MN STAT 152.18, or any similar law of another state or federal law? No 6. If you indicated in any of the preceding questions that you have received a conviction or convictions, please indicate the nature, date and location of the offense or offenses, the disposition, as well as the terms of any probation requirements that you are under or have successfully completed. If you have not received a conviction or convictions, type N/A. Note: if offered this position, you will be subject to a thorough background pursuant to MN STAT 626.87 and MN RULES 6700.0700. 7. Which of the following best describes your experience as a fulltime sworn law enforcement officer, since 2008? Less than 1 year More than 1 year, but less than 5 5 years+ N/A my experience as a fulltime sworn law enforcement office was prior to 2008 N/A I do not have any employment experience as a fulltime sworn law enforcement officer 8. Which of the following best describes your active duty military police experience, since 2008? Less than 1 year More than 1 year, but less than 5 5 years+ N/A none: my employment experience as military police was prior to 2008 N/A I do not have any employment experience as military police 9. Which of the following best describes your active duty military experience, other than military police experience, since 2008? Less than 1 year More than 1 year, but less than 5 5 years+ N/A none: my active duty military experience, other than military police, was prior to 2008 N/A I do not have any active duty military experience
10. Which of the following best describes your public contact/face to face customer service related experience, other than police experience, since 2008? Less than 1 year More than 1 year, but less than 5 5 years+ N/A none: my customer service experience, other than police officer experience, was prior to 2008 N/A I do not have any public contact/customer service experience 11. Which of the following best describes your public safety related experience in corrections, park ranger, security guard or working in a locked facility, since 2008? Less than 1 year More than 1 year, but less than 5 5 years N/A none: my experience was prior to 2008 N/A I do not have any public safety related experience as described above 12. Have you had an internship in the public safety field? No Signature Date Please be advised that in accordance with the Minnesota Uniform Transaction Act, an electronic signature on this document is binding and afforded the same effect as if the document was signed by hand.