RECRUITMENT
JOB APPLICATION PACKAGE
POLICE DEPARTMENT BALTIMORE, MARYLAND
Stages of processing for Police Officer and Cadet Applicants 1.
Civil Service Test.
2.
The Preliminary Interview. Interview and collection of documents (Original and Two (2) photocopies) on separate sheets of 8 ½ X 11 paper.
3.
Agility Test. Conducted on Saturdays and by special appointment ONLY.
4.
Paperwork gets forwarded to the Applicant Investigation Unit upon successful completion of the Agility Test.
POLICE DEPARTMENT BALTIMORE, MARYLAND
POLICE OFFICER TRAINEE APPLICANT ***IMPORTANT*** Fill out the attached package of forms and bring them with you when required for continued processing. Ensure you legibly print or type ALL information requested. Additionally, it will be necessary for you to provide the original copies of the below listed documents at that time, as well as two photocopies of each. All copied documents should be on 8½” x 11” paper. Failure to adhere to this request will delay your processing. 1.
Birth Certificate.
2.
High School Diploma or GED certificate (out-of-state certificates must meet Maryland High School Equivalence Standards).
3.
Official High School TranscriptS showing date of graduation. HIGH SCHOOL TRANSCRIPTS MUST COME TO US AS SEALED BY THE ISSUING SCHOOL. Do not make copies of High School Transcripts.
4.
Any College Diplomas with official transcripts.
5.
Selective Service Registration Form (SSS Form 3A).
6.
Form DD214, Separation or Release from the United States Armed Forces, for each term of service. Note: Member #4 must be provided in the case of recently issued forms.
7.
Marriage License, Divorce Decree and/or Legal Separation papers.
8.
Valid Motor Vehicle Operator’s License.
9.
Current certified copy of Driving Record.
10.
Naturalization Papers in cases of Naturalized Citizens.
11.
Social Security Card.
12.
Official letter on school letterhead verifying graduation. NOTE: Applicant may be required to furnish Medical Records in the event of past injury or illness. IF YOU HAVE ANY QUESTIONS PERTAINING TO THE ABOVE, CONTACT THE RECRUITMENT UNIT AT 410-396-2340. THE MAILING ADDRESS TO THE RECRUITMENT UNIT IS: Baltimore Police Department Personnel/Recruitment Section 242 W. 29th Street Baltimore, Maryland 21211-2908
POLICE DEPARTMENT BALTIMORE, MARYLAND
NOTICE TO ALL APPLICANTS Willful FALSE or MISLEADING answers to questions shall be grounds for REJECTION. ALL background checks include contact with the FBI, other State, City and County POLICE DEPARTMENTS, Motor Vehicle Administration, schools, hospitals, physicians, former employers, neighborhoods, etc. INSTRUCTIONS FOR FILLING OUT THIS PACKET OF FORMS Please fill out all of the forms in this packet. Some are in duplicate. IF YOU DO NOT UNDERSTAND A FORM - DO NOT COMPLETE IT. Wherever you see the word WITNESS on a form, DO NOT sign the line that follows it. A minimum of five personal references are required (NON-FAMILY MEMBERS). Enclosed you will find a form with a list which applies to you when you report to Recruitment for processing. If there are any questions about this packet, please contact the Recruitment Office at 410-396-2340 before you fill out the form. IMPORTANT Male applicants born after January 1, 1960, must furnish proof of their registration with the SELECTIVE SERVICE SYSTEM (SSS form 3A). If you do not have this document, you may call the Selective Services System National Headquarters at 708-688-6888 to inquire as to the procedure for obtaining a new copy of this document, or write to: Selective Services System P.O. Box 4638 North Suburban, IL 60198 Include your name, social security number, date of birth, and address at time of registration. Internet users may go to www.sss.gov for more information.
Personnel Section Application for Employment Form 403/79
POLICE DEPARTMENT BALTIMORE, MARYLAND
APPLICATION FOR EMPLOYMENT INSTRUCTIONS: TYPE OR PRINT. SIGN IN INK. EACH REQUEST FOR APPOINTMENT REQUIRES A SEPARATE APPLICATION. Before completing this application, read the position announcement to be sure you have the minimum qualifications needed for this position. Then complete the application fully. Read and sign affirmation.
OMISSIONS MAY RESULT IN REJECTION OF APPLICATION APPLICATION FOR APPOINTMENT TO THE POSITION OF ____________________. 1. Name in full: _________________________________________________________ Last
First
Middle
Phone number (including area code): ______________________________________ What other names have you been known by?________________________________ Female applicants must furnish maiden name: _______________________________ 2. Address:_____________________________________________________________ Street
City
State
Zip Code
How long have you lived in Baltimore City? _________________________________ How long have you lived in Maryland? _____________________________________ 3. Date of Birth:__________________________ Present age: ___________________ 4. Are you a citizen of the United States?______________________ 5. Proof of Citizenship attached TNo TYes__________________ (IE: Copy of Birth Certificate) 6. Do you possess a valid Operator’s License? TNo TYes ______________________ State
Number
7. Education: Name & Address of School
Years Attended From To
High School College Business School THIS SECTION CONTINUED ON ATTACHED PAGES
T Yes T No
Course Diploma or Degree
POLICE DEPARTMENT BALTIMORE, MARYLAND 8. Employment Records: Social Security Number: _______________________________________________ Name and Address of Employer Position and Type of Work
Employed
From
To
Reason for leaving
9. United States Military Service: TNo TYes Branch of Service: _________________ Date of Entry: ___________________ Date of Discharge: ____________________ Month/Day/Year
Month/Day/Year
Type of Discharge: ____________________ Serial No.: ______________________ 10. Have you ever previously applied for any position in the Baltimore Police Department or any other Law Enforcement Agency or Correctional Institution?
TNo TYes What Agency?________________________ When?_______________ What Position?_______________________________________________________ 11. List all convictions (include traffic arrests): _________________________________
12. Have you ever been a defendant in any court action? TNo TYes Describe ___________________________________________________________ ___________________________________________________________________ 13. Are you now or have you ever been a member of any organization, corporation, company, partnership, association, trust, foundation, fund, club, society, committee, political party, or any group of persons, whether or not incorporated, which engages in or advocates, abets, advises or teaches, or follows a purpose which is to engage in or advocate, abet, assist in the overthrow, destruction or alteration of the Constitutional form of government of the United States or of the State of Maryland, or of any political subdivision of either of them, by revolution, force, violence or other unlawful means?
TNo TYes Describe ________________________________________________ __________________________________________________________________ 14. I hereby affirm that there are no intentional misrepresentations or falsifications in the foregoing statements and answers to questions. I am aware that should investigation disclose any such misrepresentations or falsifications, my application shall be rejected or, if already employed, my employment may be terminated.
__________________________________ Applicant’s Signature THIS SECTION CONTINUED ON ATTACHED PAGES
T Yes T No
Date
Personnel Section Employment Reference Form PE/124
POLICE DEPARTMENT BALTIMORE, MARYLAND
EMPLOYMENT REFERENCE STARTING WITH THE DATE YOU LEFT HIGH SCHOOL, ACCURATELY ACCOUNT FOR ALL PERIODS OF EMPLOYMENT AND UNEMPLOYMENT IN DATE ORDER, INCLUDING YOUR PRESENT EMPLOYER. INCLUDE ALL SEASONAL, TEMPORARY, OR PART-TIME JOBS YOU HAVE HELD WHILE FURLOUGHED OR LAID-OFF FROM YOU PERMANENT JOB. ANSWER ALL QUESTIONS. PLEASE PRINT OR TYPE Have you ever applied for or collected unemployment compensation? TYes TNo Have you ever applied for or collected workman’s compensation? TYes TNo Have you ever filed for bankruptcy? TYes TNo Social Security Number: ______________________________________________________ 1 EMPLOYER:_______________________________________ PHONE: __________________ ADDRESS: __________________________________________________________________ CITY: ___________________________ STATE:____________
ZIP: __________________
EMPLOYED FROM: ________________ TO: _______________ SALARY: ______________ REASON FOR LEAVING: ______________________________________________________ POSITION: ________________________ DUTIES: _________________________________ CO-WORKER: ________________________________ PHONE: _______________________ ADDRESS: _________________________________________________________________ CITY: ____________________________ STATE: _______________ ZIP: ______________ CO-WORKER: ________________________________ PHONE: ______________________ ADDRESS: _________________________________________________________________ CITY: _____________________________ STATE: ______________ ZIP: _______________
SIGNATURE: ___________________________________ DATE: ________________
CONTINUED ON NEXT PAGE
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2
POLICE DEPARTMENT BALTIMORE, MARYLAND
EMPLOYER:_______________________________________ PHONE: __________________ ADDRESS: __________________________________________________________________ CITY: ___________________________ STATE:____________
ZIP: __________________
EMPLOYED FROM: ________________ TO: _______________ SALARY: ______________ REASON FOR LEAVING: ______________________________________________________ POSITION: ________________________ DUTIES: _________________________________ CO-WORKER: ________________________________ PHONE: _______________________ ADDRESS: _________________________________________________________________ CITY: ____________________________ STATE: _______________ ZIP: ______________ CO-WORKER: ________________________________ PHONE: ______________________ ADDRESS: _________________________________________________________________ CITY: _____________________________ STATE: ______________ ZIP: _______________
3 EMPLOYER:_______________________________________ PHONE: __________________ ADDRESS: __________________________________________________________________ CITY: ___________________________ STATE:____________
ZIP: __________________
EMPLOYED FROM: ________________ TO: _______________ SALARY: ______________ REASON FOR LEAVING: ______________________________________________________ POSITION: ________________________ DUTIES: _________________________________ CO-WORKER: ________________________________ PHONE: _______________________ ADDRESS: _________________________________________________________________ CITY: ____________________________ STATE: _______________ ZIP: ______________ CO-WORKER: ________________________________ PHONE: ______________________ ADDRESS: _________________________________________________________________ CITY: _____________________________ STATE: ______________ ZIP: _______________
SIGNATURE: ___________________________________ DATE: ________________ CONTINUED ON NEXT PAGE
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4
POLICE DEPARTMENT BALTIMORE, MARYLAND
EMPLOYER:_______________________________________ PHONE: __________________ ADDRESS: __________________________________________________________________ CITY: ___________________________ STATE:____________
ZIP: __________________
EMPLOYED FROM: ________________ TO: _______________ SALARY: ______________ REASON FOR LEAVING: ______________________________________________________ POSITION: ________________________ DUTIES: _________________________________ CO-WORKER: ________________________________ PHONE: _______________________ ADDRESS: _________________________________________________________________ CITY: ____________________________ STATE: _______________ ZIP: ______________ CO-WORKER: ________________________________ PHONE: ______________________ ADDRESS: _________________________________________________________________ CITY: _____________________________ STATE: ______________ ZIP: _______________
5 EMPLOYER:_______________________________________ PHONE: __________________ ADDRESS: __________________________________________________________________ CITY: ___________________________ STATE:____________
ZIP: __________________
EMPLOYED FROM: ________________ TO: _______________ SALARY: ______________ REASON FOR LEAVING: ______________________________________________________ POSITION: ________________________ DUTIES: _________________________________ CO-WORKER: ________________________________ PHONE: _______________________ ADDRESS: _________________________________________________________________ CITY: ____________________________ STATE: _______________ ZIP: ______________ CO-WORKER: ________________________________ PHONE: ______________________ ADDRESS: _________________________________________________________________ CITY: _____________________________ STATE: ______________ ZIP: _______________
SIGNATURE: ___________________________________ DATE: ________________ CONTINUED ON NEXT PAGE
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6
POLICE DEPARTMENT BALTIMORE, MARYLAND
EMPLOYER:_______________________________________ PHONE: __________________ ADDRESS: __________________________________________________________________ CITY: ___________________________ STATE:____________
ZIP: __________________
EMPLOYED FROM: ________________ TO: _______________ SALARY: ______________ REASON FOR LEAVING: ______________________________________________________ POSITION: ________________________ DUTIES: _________________________________ CO-WORKER: ________________________________ PHONE: _______________________ ADDRESS: _________________________________________________________________ CITY: ____________________________ STATE: _______________ ZIP: ______________ CO-WORKER: ________________________________ PHONE: ______________________ ADDRESS: _________________________________________________________________ CITY: _____________________________ STATE: ______________ ZIP: _______________
7 EMPLOYER:_______________________________________ PHONE: __________________ ADDRESS: __________________________________________________________________ CITY: ___________________________ STATE:____________
ZIP: __________________
EMPLOYED FROM: ________________ TO: _______________ SALARY: ______________ REASON FOR LEAVING: ______________________________________________________ POSITION: ________________________ DUTIES: _________________________________ CO-WORKER: ________________________________ PHONE: _______________________ ADDRESS: _________________________________________________________________ CITY: ____________________________ STATE: _______________ ZIP: ______________ CO-WORKER: ________________________________ PHONE: ______________________ ADDRESS: _________________________________________________________________ CITY: _____________________________ STATE: ______________ ZIP: _______________
SIGNATURE: ___________________________________ DATE: ________________ THIS SECTION CONTINUED ON ATTACHED PAGES
T Yes T No
PAGE _____ OF ______
Personnel Section Address History Form
POLICE DEPARTMENT BALTIMORE, MARYLAND
ADDRESS HISTORY FORM List below your: • • •
Full name. Present address and how long there. Previous addresses and how long there.
List in chronological order the full addresses of every residence since leaving elementary School (6th grade). Every address MUST include: Apartment number/ floor (when applicable), city, state and zip code. FULL NAME: ____________________________________________________________________ First Middle Maiden (if any) Last List in chronological order each place you have resided in since leaving elementary school. From To CURRENT ADDRESS month/year month/year PRESENT PREVIOUS ADDRESSES
THIS SECTION CONTINUED ON ATTACHED PAGES
T Yes T No
From To month/year month/year
Personnel Section Personal References Form
POLICE DEPARTMENT BALTIMORE, MARYLAND
PERSONAL REFERENCES List below the names, addresses and telephone numbers of five personal references (other than relatives). If any of your references are members of the Police Department, please indicate their district or assignment. ADDRESS TELEPHONE # NAME (Include City, State and Zip Code)
(Include Area Code)
-----------------------------------------------------------------------------------------------------------------The following information is necessary to conduct the required Criminal Investigation. All questions must be answered. Please print. FULL Name (Last, First, Middle)
Age
Sex
Date of Birth
Race
Maiden
Place of Birth (City/County, State, Country).
Height
Signature
Weight
Eye Color
Hair Color
Date
Personnel Section Debt Listing
POLICE DEPARTMENT BALTIMORE, MARYLAND
ITEMIZED LIST OF DEBTS NAME OF COMPANY AND ADDRESS
AMOUNT OWED
MONTHLY PAYMENT
IN ARREARS
NATURE OF DEBT
Maryland Savings & Loan
$12,569
$289
$0
New Car Loan
EXAMPLE
TOTAL DEBT Any liens, judgments or attachments?
TYes TNo
Favor of ______________________________________________________________ Amount ___________________________________
Date _____________________
I certify the above is true and correct, to the best of my knowledge and belief, and know that if the information is found to be incorrect, after investigation, it will be ground for dismissal.
Signature THIS SECTION CONTINUED ON ATTACHED PAGES
Date
T Yes T No