APPLICATION FOR EMPLOYMENT

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General Information

Every one of these sections must be completed for the City of High fill to accept the application as complete. If this question does not apply to you, so state with N/A.

Do not mistake or omit material fact, since the statements made herein are subject to verification to determine your qualifications for employment. Any false, misleading, or incomplete information will result in your application being rejected.

Once submitted, this application becomes the property of the City of Highfill.

This application consists of several sections:

Questionnaire
Application
Verification
Waiver and Release for Background Investigation

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Minimum Qualifications

An applicant shall be no less than twenty-one (21) years of age.
MUST have a high school diploma or equivalent
Applicant shall have no record of a Class A misdemeanor, felony, or violent crime.
MUST pass background investigation.
Applicant shall be physically, medically, and psychologically fit to preform essential functions of the job classifications.
MUST have a valid Arkansas driver’s license.
MUST be able to pass drug test.
For identity purposes, MUST submit a photo from the shoulders up.

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Last Name *

First Name *

Middle Name

Social Security Number *

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Aliases, Nicknames

Maiden Name, Other Changes in Name

Telephone Number *

Email *

Date of Birth *

U.S. Citizen: Native *

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Naturalization No *

Date *

Place *

Court *

Present Residence Address *

Address Line 1

City

State

Zip Code

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6. RESIDENCES

List all for past ten years beginning with current.

Residence 01

Address *

Address Line 1

City

State

Zip Code

Month From *

Month to *

Year From *

Year To *

With whom did you live and where are they now?

Checkbox Items

Add another address

Residence 02

Address *

Address Line 1

City

State

Zip Code

Month From *

Month to *

Year From *

Year To *

With whom did you live and where are they now? *

Checkbox Items (copy)

Add another address

Residence 03

Address *

Address Line 1

City

State

Zip Code

Month From *

Month to *

Year From *

Year To *

With whom did you live and where are they now?

Checkbox Items (copy) (copy)

Add another address

Residence 04

Address *

Address Line 1

City

State

Zip Code

Month From *

Month to *

Year From *

Year To *

With whom did you live and where are they now?

Checkbox Items (copy) (copy) (copy)

Add another address

Residence 05

Address *

Address Line 1

City

State

Zip Code

Month From *

Month to *

Year From *

Year To *

With whom did you live and where are they now?

Checkbox Items (copy) (copy) (copy) (copy)

Add another address

Residence 06

Address *

Address Line 1

City

State

Zip Code

Month From *

Month to *

Year From *

Year To *

With whom did you live and where are they now?

Checkbox Items (copy) (copy) (copy) (copy) (copy)

Add another address

Residence 07

Address *

Address Line 1

City

State

Zip Code

Month From *

Month to *

Year From *

Year To *

With whom did you live and where are they now?

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7. FAMILY

List all children related to you or your spouse:

Are You? *

Single
Married
Separated
Divorced
Widowed

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Name *

Relation *

Date of Birth *

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Address *

More...

Add another child

Supported by Whom *

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Name *

Relation *

Date of Birth *

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Address *

More...

Add another child

Supported by Whom *

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Name *

Relation *

Date of Birth *

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Address *

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Add another child

Supported by Whom *

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Name *

Relation *

Date of Birth *

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Address *

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Add another child

Supported by Whom *

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Name *

Relation *

Date of Birth *

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Address *

More...

Add another child

Supported by Whom *

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Name *

Relation *

Date of Birth *

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Address *

Supported by Whom *

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8. VEHICLE OPERATOR’S LICENSE

Give the following information concerning any vehicle operator’s licenses you have held or now hold:

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Type of License *

More...

Add another license

Number *

Issuing Authority *

Expiration *

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Type of License *

More...

Add another license

Number *

Issuing Authority *

Expiration *

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Type of License *

More...

Add another license

Number *

Issuing Authority *

Expiration *

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Type of License *

More...

Add another license

Number *

Issuing Authority *

Expiration *

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Type of License *

More...

Add another license

Number *

Issuing Authority *

Expiration *

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Type of License *

Number *

Issuing Authority *

Expiration *

Have you ever had a license suspended or revoked? *

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9. CONVICTION OF CRIME

Have you ever been convicted of a misdemeanor or felony? *

Indicate the state violation, court of jurisdiction, and date of conviction: *

10. PAST AND PRESENT MEMBERSHIP IN ORGANIZATIONS

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Name *

Address *

More...

Add another membership

Office Held *

Zip *

Membership dates *

Type of organization *

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Name *

Address *

More...

Add another membership

Office Held *

Zip *

Membership dates *

Type of organization *

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Name *

Address *

More...

Add another membership

Office Held *

Zip *

Membership dates *

Type of organization *

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Name *

Address *

Office Held *

Zip *

Membership dates *

Type of organization *

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11. EDUCATION

A. High Schools:

List all high schools attended. Attach transcript from last high school attended

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Name *

City/State/Zip *

Graduated *

More...

add another high school

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Name *

City/State/Zip *

Graduated *

More...

add another high school

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Name *

City/State/Zip *

Graduated *

More...

add another high school

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Name *

City/State/Zip *

Graduated *

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B. Higher Education.

List all colleges or universities attended. Attach transcript from last institution.

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Name *

City/State/Zip *

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Dates Attended *

Credit Hours *

Semester/Quarter

Graduated *

More...

Add another institute

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Name *

City/State/Zip *

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Dates Attended *

Credit Hours *

Semester/Quarter

Graduated *

More...

Add another institute

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Name *

City/State/Zip *

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Dates Attended *

Credit Hours *

Semester/Quarter

Graduated *

More...

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Name *

City/State/Zip *

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Dates Attended *

Credit Hours *

Semester/Quarter

Graduated *

12. SPECIAL QUALIFICATIONS AND SKILLS

Indicate Police Certification or any other type of special license such as pilot, radio operator, etc., showing licensing authority, where the license was first issued and date current license expires:

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13. FOREIGN LANGUAGE

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Language

More...

add another language

Reading *

Speaking *

Understanding *

Writing *

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Language

More...

add another language

Reading *

Speaking *

Understanding *

Writing *

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Language

Reading *

Speaking *

Understanding *

Writing *

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14. HOBBIES AND SPORTS

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Name *

Length of Participation *

Level of Proficiency *

More...

Add another hobby

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Name *

Length of Participation *

Level of Proficiency *

More...

Add another hobby

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Name *

Length of Participation *

Level of Proficiency *

More...

Add another hobby

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Name *

Length of Participation *

Level of Proficiency *

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15. EMPLOYMENT

Begin with your most recent job and list your work history for the past ten (10) years, including part-time, temporary or seasonal employment, and all periods of unemployment.

Are you now or have you been a Law Enforcement Officer? *

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From *

Salary *

Name of Supervisor *

Name of Co-Worker *

More...

Add Another Employment

To *

Job Title *

Phone of Supervisor

Phone of Co-Worker *

Employer Name/Address/Phone Number *

Description of Duties *

Why did you leave? *

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From *

Salary *

Name of Supervisor *

Name of Co-Worker *

More...

Add Another Employment

To *

Job Title *

Phone of Supervisor

Phone of Co-Worker *

Employer Name/Address/Phone Number *

Description of Duties *

Why did you leave? *

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From *

Salary *

Name of Supervisor *

Name of Co-Worker *

More...

Add Another Employment

To *

Job Title *

Phone of Supervisor

Phone of Co-Worker *

Employer Name/Address/Phone Number *

Description of Duties *

Why did you leave? *

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From *

Salary *

Name of Supervisor *

Name of Co-Worker *

To *

Job Title *

Phone of Supervisor

Phone of Co-Worker *

Employer Name/Address/Phone Number *

Description of Duties *

Why did you leave? *

Have you ever been discharged, asked to resign, furloughed, or put on inactive status for cause, or subject to disciplinary action while in any position (except military)? *

State reason: *

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16. MILITARY STATUS

Have you ever served in the U.S. Armed Forces? *

Do you claim veteran’s preference? *

Are you presently a member of a U.S. Reserve or State Guard organization? *

17. FINANCIAL STATUS

Give names 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 number where applicable.

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Name and Address of Creditor *

Reason for Debt or Item Purchased *

Type *

Total Balance

Account Number

Monthly Payments

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Add another debt

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Name and Address of Creditor *

Reason for Debt or Item Purchased *

Type *

Total Balance

Account Number

Monthly Payments

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Add another debt

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Name and Address of Creditor *

Reason for Debt or Item Purchased *

Type *

Total Balance

Account Number

Monthly Payments

More...

Add another debt

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Name and Address of Creditor *

Reason for Debt or Item Purchased *

Type *

Total Balance

Account Number

Monthly Payments

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Add another debt

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Name and Address of Creditor *

Reason for Debt or Item Purchased *

Type *

Total Balance

Account Number

Monthly Payments

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Add another debt

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Name and Address of Creditor *

Reason for Debt or Item Purchased *

Type *

Total Balance

Account Number

Monthly Payments

More...

Add another debt

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Name and Address of Creditor *

Reason for Debt or Item Purchased *

Type *

Total Balance

Account Number

Monthly Payments

More...

Add another debt

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Name and Address of Creditor *

Reason for Debt or Item Purchased *

Type *

Total Balance

Account Number

Monthly Payments

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18. CHARACTER REFERENCES

List only character references who have definite knowledge of your qualifications for the position of application. List five (5) character references. Do not list relatives or persons living outside of the United States.

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Name *

Address *

Home Phone *

Work Phone

Years Known *

More..

Add another reference

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Name *

Address *

Home Phone *

Work Phone

Years Known *

More..

Add another reference

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Name *

Address *

Home Phone *

Work Phone

Years Known *

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Add another reference

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Name *

Address *

Home Phone *

Work Phone

Years Known *

More..

Add another reference

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Name *

Address *

Home Phone *

Work Phone

Years Known *

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19. GOVERNMENTAL AGENCIES

Have you ever applied for a position with any other governmental agencies?

Give details *

20. REMARKS

I certify that there are no misrepresentations, omissions, or falsifications in the foregoing statements and answers, and that the entries made by me above are true, complete, and correct to the best of my knowledge and belief and are made in good faith.

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Signature *

Date *

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VERIFICATION

The information I have provided in the application is true and correct to the best of my knowledge, belief, and understanding. I understand that any false statement contained therein is subject to penalties prescribed by Arkansas Criminal Statutes, relating to unsworn falsification to authorities.

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Signature *

Date *

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Email *

The Official Recruitment Site of the Highfill Police Department.

APPLICATION FOR EMPLOYMENT

General Information

Minimum Qualifications

6. RESIDENCES

7. FAMILY

8. VEHICLE OPERATOR’S LICENSE

9. CONVICTION OF CRIME

10. PAST AND PRESENT MEMBERSHIP IN ORGANIZATIONS

11. EDUCATION

A. High Schools:

B. Higher Education.

12. SPECIAL QUALIFICATIONS AND SKILLS

13. FOREIGN LANGUAGE

14. HOBBIES AND SPORTS

15. EMPLOYMENT

16. MILITARY STATUS

17. FINANCIAL STATUS

18. CHARACTER REFERENCES

19. GOVERNMENTAL AGENCIES

20. REMARKS

VERIFICATION

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