Home / perf of indiana phone number / Reserve Application

Reserve Application - perf of indiana phone number



Internal Use Only
Name: __________________________________
(Print or Type) Date: ___________________

Social Security Number: ___________________ (optional) Time: ___________________




Police Officer Application Information Summary


POLICE DEPARTMENT


City of Elkhart


[pic]







STATEMENT OF EQUAL EMPLOYMENT OPPORTUNITY


The City of Elkhart is an Equal Opportunity Employer and will accept applications, hire qualified
applicants, administer all terms and conditions of employment and make available all benefits and
compensation of employment without regard to race, color, creed, religion, sex, national origin, disability,
or age, except when such constitutes a bona fide occupational qualification necessary for proper and
efficient administration of the agency.











INSTRUCTIONS

1. Read each item carefully.
2. This application must be typed or printed neatly in ink.
3. All items must be completed and necessary documentation included.
4. If additional space is needed, attach a supplemental page at the end of the application.
5. The completed application must be returned to:
Elkhart Police Department
175 Waterfall Drive
Elkhart, IN 46516
Services Division


POLICY REGARDING THE APPLICANT INFORMATION SUMMARY

1. The failure to comply with instructions and policy regarding this phase of the applicant selection process may result in the rejection of the application.

2. The failure to accurately and truthfully complete this application may result in the rejection of the application.

3. The failure to return this application by the specified date may result in the rejection of the application.

4. Applications will not be accepted without complete addresses, phone numbers, and zip codes.

5. The applicant MUST HAVE the General Authorization for Release on page 12 and the Consent to Procurement of Consumer Credit Report on page 13 notarized before returning the application. Failure to do so will significantly hinder the process.

6. It is the responsibility of the applicant to advise or forward any changes relative to applicant’s name, address, and phone number.


If you are in need of assistance in completing the application form, feel free to contact the Services Division of the Elkhart Police Department at (574) 295-7070.

                                    ELKHART POLICE DEPARTMENT



Basic Requirements:


• Applicants must be at least 21 years of age when they apply and under the age of 36 years at the time of hire.
• Applicant must be a high school graduate or possess a GED.
• Applicant must be a U.S. citizen.
• Applicant cannot have any Felony convictions or convictions for Domestic Violence.
• Applicant must have or be able to obtain a valid Indiana drivers license.




I, _______________________________ verify that I meet all of the above listed basic requirements.
(Print or type)


_________________________ __________
Signature Date



Procedures:

1. Submit completed application with specified certificates and documents.
2. Participate in the testing procedures including the agility test, PEP test, and written test.
3. Background investigation.
4. Captains review board.
5. Board of Safety Interview.
6. Truth verification.
7. Physical and psychological examinations.
8. Approval by local Pension Board.
9. Final approval by state PERF board.









I. PERSONAL HISTORY

A. Name in full (last, first, middle): __________________________________________
B. Social Security Number: ______ - ______ - ______
C. List all other names you have used including nicknames and maiden names. If you have ever used any last names other than your true name, list the period of time during in which it was used and the circumstances for its use. If you have ever legally changed your name, list the date, place, and the court. This information is required to assist the department in conducting the applicant’s background investigation.
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

D. Birth Date (month, day, year): _____________________________________________________
Place of birth (city, state): _________________________________________________________
Include a COPY of your birth certificate. This will be used to verify your age for statutory requirements.
E. Are you a United States citizen? Yes ______ No ______

II. FAMILY HISTORY
List all family members (living or deceased) in the following order: parents, step-parents, foster parents, guardians, brothers, sisters, spouse, children:


RELATIONSHIP NAME PRESENT ADDRESS AND PHONE (if living)
________________ ____________________ _______________________________________
________________ ____________________ _______________________________________
________________ ____________________ _______________________________________
________________ ____________________ _______________________________________
________________ ____________________ _______________________________________
________________ ____________________ _______________________________________
________________ ____________________ _______________________________________
________________ ____________________ _______________________________________
________________ ____________________ _______________________________________
________________ ____________________ _______________________________________
________________ ____________________ _______________________________________
________________ ____________________ _______________________________________
________________ ____________________ _______________________________________
________________ ____________________ _______________________________________


III. RESIDENCES
A. Present Residence:
____________ _________________ ______________ ___________ _________
(Number) (Street) (City) (State) (ZIP)

Telephone number: ( ) _______ - _________

Cell/other phone ( ) _______ - _________

E-mail address: _____________________________________________________

B. In chronological order, with the most current first, list all of your residences in the last five years:


Dates Address
From --- To Number Street City State ZIP
_____-_____ __________________________________________________________
_____-_____ __________________________________________________________
_____-_____ __________________________________________________________
_____-_____ __________________________________________________________
_____-_____ __________________________________________________________
_____-_____ __________________________________________________________
_____-_____ __________________________________________________________
IV. EDUCATION
List all schools attended at the high school level and above. Include COPIES of all transcripts, diplomas and degrees.


Years Attended Address Degree / Diploma
From To
High Schools
_____ _____
_____ _____
Colleges / Universities
_____ _____
_____ _____
_____ _____
Other, Vocational, Technical, etc…
_____ _____
_____ _____





V. EMPLOYMENT RECORD
In chronological order list all former and current employers. Include full-time, part-time, temporary/seasonal work, and all periods of unemployment. Present employers will be contacted prior to any appointment: make sure all telephone numbers are correct:


1. Employment Dates: From __________ To __________
Name of Company:
Address & ZIP code:
Phone Number: ( )
Position Held:
Supervisor’s Name:
Reason for Leaving: Final Salary _______________


2. Employment Dates: From __________ To __________
Name of Company:
Address & ZIP code:
Phone Number: ( )
Position Held:
Supervisor’s Name:
Reason for Leaving: Final Salary _______________


3. Employment Dates: From __________ To __________
Name of Company:
Address & ZIP code:
Phone Number: ( )
Position Held:
Supervisor’s Name:
Reason for Leaving: Final Salary _______________


4. Employment Dates: From __________ To __________
Name of Company:
Address & ZIP code:
Phone Number: ( )
Position Held:
Supervisor’s Name:
Reason for Leaving: Final Salary _______________


5. Employment Dates: From __________ To __________
Name of Company:
Address & ZIP code:
Phone Number: ( )
Position Held:
Supervisor’s Name:
Reason for Leaving: Final Salary _______________


6. Employment Dates: From __________ To __________
Name of Company:
Address & ZIP code:
Phone Number: ( )
Position Held:
Supervisor’s Name:
Reason for Leaving: Final Salary _______________


7. Employment Dates: From __________ To __________
Name of Company:
Address & ZIP code:
Phone Number: ( )
Position Held:
Supervisor’s Name:
Reason for Leaving: Final Salary _______________


8. Employment Dates: From __________ To __________
Name of Company:
Address & ZIP code:
Phone Number: ( )
Position Held:
Supervisor’s Name:
Reason for Leaving: Final Salary _______________


VI. MILITARY SERVICE
A. Are you registered with the Selective Service?
Yes No
Selective Service Number:

B. Have you ever served on active duty in the Armed Forces of the United States?
Yes No

Branch of Service:
Army
Navy
Air Force
Marine Corps
Coast Guard
National Guard ______

Dates of Active Duty:
(Month, Day, Year)
Last held rank: ______________________________________________
Type of Discharge:

C. While in the Military Service, were you ever convicted of any offense (civil or military)?
Yes No
When?
Explain:


D. Include COPY 4 of your DD214 - (Armed Services Discharge)


VII. DRIVER RECORD
A. List all vehicle operator licenses you currently hold or have held:
Include a COPY of your current license


License Type Licensing License Number Expiration
(Oper. / Chauf / CDL) State Date








B. List all vehicle accidents that you have been involved in over the last five years:
Date Location Description





C. List all traffic citations you have received in the past three years:
Date Location Description






D. Has your driver’s license ever been suspended or revoked?
Yes No
If yes, explain:




VIII. ARREST / FELONY / MISDEMEANOR CONVICTION RECORD



A. Have you ever been convicted of a felony offense?
Yes No
If yes, provide the following:
Date Place Charges/Disposition




C. Have you ever been convicted of a misdemeanor offense?
Yes No
If yes, provide the following:
Date Place Charges/Disposition




D. Use this area for further clarification regarding any of the above:








IX. REFERENCES
List three current references. (Excluding relatives, current and former employers):


1. Name:
Address and ZIP code:
Daytime Telephone Number: ( )
Cell Phone / Pager: ( )
Occupation:
How long have you known this individual?




2. Name:
Address and ZIP code:
Daytime Telephone Number: ( )
Cell Phone / Pager: ( )
Occupation:
How long have you known this individual?



3. Name:
Address and ZIP code:
Daytime Telephone Number: ( )
Cell Phone / Pager: ( )
Occupation:
How long have you known this individual?








[pic]
RECORDS CHECK
GENERAL AUTHORIZATION FOR RELEASE

I hereby authorize any and all schools, Armed Services, employers, law enforcement agencies, or any other person or organization or agency to furnish to the Elkhart Police Department, or its designated agent(s), any and all information, opinions, or documents which may be requested; to allow the visual inspection and copy of all reports, photographs, or other documents.

I hereby waive any objection to the release of said information and grant the Elkhart Police Department, or its designated agent(s), any right I may have to said information.

I hereby authorize access to the public view of any social network accounts I may have. I understand that this information in itself will not disqualify me, but will provide the agency with additional information that will assist in a reasonable background investigation.

I also authorize investigation of all statements made in my application for employment.

______________________________
Applicant’s Signature (Full legal name)


REFERENCE CHECK

AUTHORIZATION AND WAIVER

I hereby authorize all schools and previous employers to furnish the City of Elkhart my record, reason for leaving, and all information they may have concerning me, and I hereby release them and the City of Elkhart and its employees from liability for any damage whatsoever arising there from. I also authorize investigation of all statements made in the application. I understand that in the event of my employment with the City of Elkhart, I shall be subject to dismissal if any of the information I have given in this application is false or if I have failed to give any material information herein requested.

_________________________________ ___________________________________
Date Applicant’s Signature (Full legal name)


S) State of Indiana

S) County of ______________________________

Before me, the undersigned, a Notary Public, for _____________________________County. State of Indiana,

personally appeared the above subject, ______________________________and acknowledged the execution of

the foregoing instrument this __________________ day of _______________, 20________.

________________________________________________

Notary Public (__________________________________)
Print name
Resident of ________________________________County


Commission Expires ______________________________
[pic]


CONSENT TO PROCUREMENT OF CONSUMER CREDIT REPORT

I understand that, as a condition of my consideration for employment with the City of Elkhart, the Elkhart Police Department may obtain a consumer report that includes, but is not limited to, my creditworthiness or similar characteristics, employment and education verifications, social security verification, criminal and civil history, personal interviews, BMV records, any other public records and any other information bearing on my credit standing, credit capacity, character, general reputation, personal characteristics and trustworthiness.
I hereby authorize and consent to the Elkhart Police Department’s procurement of such a report. I understand that, pursuant to the federal Fair Credit Reporting Act, the Elkhart Police Department will provide me with a copy of any such report if the information contained in such report is, in any way, to be used in making a decision regarding my fitness for employment with the City of Elkhart I further understand that such report will be made available to me prior to any such decision being made, along with the name and address of the reporting agency that produced the report.

________________________________________
Signature of Applicant or Employee              Date

________________________________________
Printed Name of Applicant or Employee

S) State of Indiana
S) County of ______________________________

Before me, the undersigned, a Notary Public, for _____________________________County, State of Indiana,

personally appeared the above subject, ______________________________and acknowledged the execution of

the foregoing instrument this __________________ day of _______________, 20________.

________________________________________________

Notary Public (__________________________________)
Print name
Resident of ________________________________County


Commission Expires __________________






Nepotism Form


|Name |Position Applied For |
| | |

To comply with Indiana Code 36-1-20 regarding the employment of relatives in local government that was placed into law effective July, 1, 2012 we require the following information. Please fill out the information below and return it with your application.
If none, please indicate so.

|Relatives currently employed by City of Elkhart (include “step”, “half” & “in-law” relations) additional space is available below the |
|signature box if needed |
|Name | |Relationship | |
|Name | |Relationship | |
|Name | |Relationship | |
|Name | |Relationship | |
|Name | |Relationship | |
|Name | |Relationship | |
|Name | |Relationship | |
|Name | |Relationship | |
|Name | |Relationship | |
|Name | |Relationship | |
|Name | |Relationship | |
|Name | |Relationship | |

I certify that all information provided on this form is true. I understand that if a job is offered the offer may be rescinded based on the information provided above in compliance with Indiana law. I further understand that any false statement made herein is sufficient reason for the City of Elkhart to rescind the employment offer or for termination of subsequent employment regardless of date of discovery.


| | |
| | |
| | |
|Signature of Applicant |Date |

Applicant Checklist


Please use the following list as a guide in completing your application. Supply COPIES of all documents (not originals unless specified).

____ Records Check Authorization Release (MUST BE NOTARIZED) Original

____ Consent to Procurement of Consumer Credit Report (MUST BE NOTARIZED)
Original

____ Birth Certificate (copy)

____ OFFICIAL High School and College Transcripts (copies)

____ High School and College Diplomas (copies)

____ DD214 *Armed Services Discharge (COPY 4)

____ Driver License (copy – picture side only)

____ Full Names and Complete Addresses of Family Members

____ Full Addresses and Dates of Prior Residences (past five years)

____ Complete Information Pertaining to Employers

____ Selective Service Number

____ Complete Driver License Information

____ Information Concerning any Accidents

____ Information Concerning any Arrests

____ Complete Information Relating to Three References

____ Nepotism Form
* If you are unable to provide some of this information or if you are waiting for information that you have requested please, provide a written explanation on your application.




KEEP THIS PAGE FOR YOUR RECORDS


GENERAL HIRING PROCEDURES

The following pages contain the procedures adopted by the Board of Safety of the City of Elkhart and the Elkhart Police Department. Applicants or potential applicants reviewing these procedures should keep in mind that each step outlined is a separate and distinct requirement calling for commitment on their part, and overall constitute a total process. Each step must be successfully completed in order to meet eligibility requirements.

It is the responsibility of each applicant to fully understand and complete each step as outlined.  The Elkhart Police Department will assist each applicant as needed or requested in fully understanding all procedures and requirements. Any applicant who wishes may contact the departments Services Division by calling 574-295-7070, with questions or for further clarification of any part of this procedure.


FORMATION OF A HIRING POOL:

The Elkhart Police Department accepts applications daily.  Applications may be picked from the police department or may be found online at the department website.  Every attempt will be made by the police department to publicize the departments hiring process.  The department will continually contact appropriate groups, organizations, and persons to assure that the widest possible group of individuals from all aspects of the community is aware of the process.

Upon the completion of one hiring pool the Services Division of the police department will notify the next group of applicants that has been received of the next stage of the hiring process.  The Services Division will then ensure that the next 3 stages are completed.  If and when an opening on the department occurs the Services Division will then ensure that the rest of the procedure is followed until the opening is filled. 


LETTER TO APPLICANT:

Dear Applicant,

Attached you will find a copy of the hiring procedure used by the City of Elkhart, Indiana and the Elkhart Police Department. This procedure has been approved and adopted by the City and the Board of Public Safety. The purpose of this procedure is to ensure that the best qualified applicants are selected to serve as police officers with the City, and that should you become a member of the police department, you can be proud to be a part of a truly professional organization.

This procedure and policy take into consideration requirements by the American Disabilities Act, The Public Employees Retirement Fund, and the City of Elkhart Board of Public Safety. Also included are any optional standards adopted by the Police Departments local Pension Board under the laws of the State of Indiana.

The purpose of this packet is to inform you of all the steps necessary for you to successfully complete in order to be considered for hiring by the Elkhart Police Department.  You will see that the process is not an easy one and can take a significant commitment on your part in addition to being time consuming for both you and the persons involved in the hiring process.

The City of Elkhart is an equal opportunity employer and is committed to hiring only the most qualified individuals for its Police Department. With this in mind and as you review the attached material, we wish you well in your attempt to join a professional organization and in seeking what may be for you a truly rewarding career.





KEEP THIS PAGE FOR YOUR RECORDS

1.  APPLICATION:

The first step in the hiring process is the written application.  Applications may be picked up at the front desk of the Police Department or found online at the Police Departments web site.  The application is reviewed and evaluated on its content and neatness.  Failure to comply with instructions and policy regarding this phase of the applicant selection process, and failure to accurately and truthfully complete the application including complete addresses, phone numbers, and zip codes may result in its rejection. The applicant must have the General Authorization for Release on page 12 and the Consent to Procurement of Consumer Credit Report on page 13 notarized before returning the application.  It is also the applicant’s responsibility to advise or forward any changes relative to the applicants name, address, and phone number.  If the applicant is in need of assistance in completing the application he/she should feel free to contact the Services Division at (574) 295-7070.



2.  AGILITY TEST, PERSONNEL EVALUATION PROFILE TEST, and WRITTEN EXAM:

Upon the completion of one hiring pool the Services Division of the police department will notify the next group of applicants that has been received of the next stage of the hiring process. This notification will be by letter.  The letter will detail the time and place of the testing. All three tests will be administered on the same day.  
• AGILITY TEST: The Elkhart Police department has adopted the Indiana Law Enforcement Academy physical fitness test as its agility test. The applicants will be tested in push ups, sit ups, vertical leap, 300 meter sprint, and 1 ½ mile run.  The standards for each event will be included in the letter. A waiver or disclaimer will also be included and must be signed by the applicant and turned in on the day of testing. This disclaimer will release the city and police department from all liability should any injury occur during the agility testing process.
• PERSONNEL EVAULATION PROFILE TEST:  The PEP test is used to gauge an applicant’s ethics and attitudes towards drugs, reporting theft, socialization, customer service, employment background, absenteeism, and tardiness.  The PEP test was developed by P.E. Inc. and is used by police department’s nationwide.  The test is graded by P.E. Inc. on a 0 to 100 point scale. A low score indicates that the applicant might be a high risk applicant.
•  WRITTEN EXAMINATION:  The written examination will measure and grade qualities and skills deemed to be necessary in good police candidates.   The specific written instrument or test may vary or change from process to process taking into consideration the intent of the department and city administration to stay current with the latest standards and professional thought processes dealing with applicant selection and additionally any legal considerations deemed appropriate by the city legal department.  A minimum score may be required as decided upon by the police department after considering all legal aspects and requirements.

Applicants will be notified by letter as to whether they passed or failed the testing stage of the process. Those who have failed the testing phase may reapply to the police department in the next hiring pool.

3.  BACKGROUND INVESTIGATION: 

Those applicants who have successfully completed the testing stage of the process will undergo an extensive background investigation.  Areas in this investigation will include but not be limited to verification of all information on the employment application, personal reference checks, neighborhood checks, spouse and family interviews, a credit check, and other areas that are deemed appropriate and allowable by law. 







KEEP THIS PAGE FOR YOUR RECORDS



4.  CAPTAINS REVIEW BOARD:

The Captains Review Board will meet as needed throughout the year.  The board will consist of the 3 Division Captains and the Assistant Chief of Police.  All the applicants who have successfully completed the 3 previous stages will have their application packet reviewed.  The board will decide if the applicant will be allowed to move onto the next stage or receive a letter rejecting their application.  Applicants who receive a letter of rejection may reapply to the department in the next hiring pool. Successful applicants will then be notified by letter detailing the next stage of the process which is the Board of Safety interview.  

5.  BOARD OF PUBLIC SAFETY INTERVIEW:

It is required that each applicant personally appear before a board of review comprised of members of the Board of Safety and the Chief of Police and/or his designated representatives.  All information pertaining to the applicant will be available for the board’s consideration. Each applicant will be asked questions by the board concerning this information during their interview.  In addition the board will be considering the demeanor of each applicant and his or her maturity and confidence, as well as answers to questions posed to them.

Following the appearance before the board the applicant will receive notification by letter indicating one of three possible board decisions:

1. A conditional offer of employment will be offered to the applicant.
2. The applicant will be retained on the Captains list to be considered for future openings.
3. The applicant will be eliminated from further consideration for employment. The applicant may reapply to the department in the next hiring pool.


Once a conditional offer of employment is tendered to the applicant he or she will continue in the process and must complete the remaining stages before being hired by the police department.



6.  TRUTH VERIFICATION:

Applicants who have been given a conditional offer must successfully complete a truth verification examination.  The method of verification used by the Elkhart Police Department is the polygraph examination.  The polygraph instrument is designed to identify deception by asking a series of questions and monitoring the applicant’s responses. The examiner may use the application, PEP test results, background investigation, and any other investigative tool to comprise a list of questions for the applicant.  The applicant will be notified by letter if he or she has successfully passed the examination. 













KEEP THIS PAGE FOR YOUR RECORDS


7.  PHYSICAL AND PSYCHOLOGICAL EXAMINATION:

Indiana state law mandates that each police applicant who receives a conditional offer of employment, and passes the truth verification examination, successfully pass a complete medical and psychological examination given by approved PERF (Public Employee Retirement Fund) physicians and psychologists.  The applicant will make all arrangements to undergo the examinations and promptly notify the Elkhart Police Department Services Division of these arrangements.  The costs of the examinations are covered by the local Pension Board.  Once received by the department, the examinations become the property of the department.  It is required that a PERF approved licensed physician and psychologist, sign off on the PERF examination booklet indicating that the applicant has met all PERF standards for employment and membership in the PERF plan. Should the examining physician or psychologist not sign the PERF booklet (indicating unsuccessful completion of the PERF examination), the applicant cannot be hired by the department.




8.   APPROVAL BY THE LOCAL PENSION BOARD:

Once the signed PERF forms are received by the department from the examining physicians, the local Pension Board must also meet to sign the PERF application.  The local Pension Board is also responsible for ensuring that the applicant meets any local standards or requirements adopted by the local board and the Board of Public Safety.




9.   FINAL APPROVAL BY STATE PERF BOARD:


After the local Pension Board signs the PERF booklets, they are sent to the state PERF board for examination and review.  The state board will then determine if the applicant is eligible, (based on physicians statements) to participate in the state PERF. They will further determine whether any excludable conditions exist that would prohibit the applicant from claiming disability pension benefits in the future. Those applicants passing the aforementioned mental and psychological examinations, and receiving endorsements from the local Pension Board and the state PERF board will be given an unconditional offer of employment by the Board of Safety, and as soon as practical, be sworn in as a probationary police officer.