Free State of Montana Public Safety Officer Job Application Form - PDF Template

Download and submit this form to the State of Montana Employment office to apply for a Job Position of a Public Safety Office.

State of Montana Public Safety Officer Job Application Form

Text Version of the Form

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S TANDARD APPLI CA TI ON FOR POSI TI ON OF
S TANDARD APPLI CA TI ON FOR POSI TI ON OF
P UBLI C SAFE TY OFFI CER IN THE S TA TE OF M ON TANA
P UBLI C SAFE TY OFFI CER IN THE S TA TE OF M ON TANA
The information contained on this form is sought in good faith. It will not be used in any way to discriminate against any
application for employment in violation of state or federal law.
INSTRUCTIONS: You may complete this application by filling it on your computer, then saving and printing the
completed form. If you prefer, you may print the application and fill it in manually. Be sure to sign it before delivering or
mailing it to the agency address on the job listing. An application tailored to the position is to your advantage.
LATE, INCOMPLETE or UNSIGNED applications will NOT be considered.
This agency is committed to making reasonable accommodation to any known disability that may interfere with an
applicant’s ability to compete in the selection process or an employee’s ability to perform the duties of the job. If you
would like us to consider any such accommodation, please notify us at the time of need.
THE VETERANS’ EMPLOYMENT PREFERENCE ACT AND THE DISABILITY PERSONS’ EMPLOYMENT
PREFERENCE ACT provide preference in public employment for certain military veterans and handicapped persons or
their eligible relatives. Contact your local Vocational Rehabilitation Services Office (Department of Public Health and
Human Services) for details on obtaining handicapped person’s certification. Contact your local Veteran’s Affairs Office
(Department of Military Affairs) for details on obtaining veteran’s preference certification. For more information, contact
your local Job Service. If you are claiming either employment preference, you must complete the Employment Preference
Form.
Last Name ___________________________________ First __________________________________ MI___________
Social Security Number ______________________________________________________________________________
Street Address _____________________________________________________________________________________
City ________________________________________ State ___________________ Zip Code ____________________
Work Phone _________________________________ Home Phone __________________________________________
E-mail Address_____________________________________________________________________________________
Do you have a valid driver’s license? Yes ( ) No ( )
My signature below certifies that all information on this and all attached pages is true, correct and complete to the best of
my knowledge and contains no willful falsifications or misrepresentations. Falsifications or misrepresentations may
disqualify me from consideration for employment or, if hired, may be grounds for termination at a later date.
EMPLOYERS MAY BE CONTACTED AS REFERENCES.
Signature _____________________________________________ Date Signed _________________________________
STANDARD APPLICATION 1 Revised 12/2008
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EDUCATION
High School Name _________________________________________________________________________________
Address of High School awarding diploma or equivalency certificate __________________________________________
Received diploma or equivalency certificate: Yes ( ) No ( ) If No, highest grade completed _________________________
College or University Name __________________________________ Dates Attended __________________________
Location ____________________________ Credit Hours Earned_________ Degrees Received (BA, MA, etc.) _______
Date of Degree _________________________Major Field _____________________Minor Field ___________________
List other schools or training that help you qualify.
Name ___________________________________________ Location _________________________________________
Dates Attended____________________________________ Did You Complete? Yes ( ) No ( )
Title/Description of Course ______________________________________________________ Total Hours ___________
PROFESSIONAL LICENSES, REGISTRATION OR CERTIFICATES (EMT, GVW, Diver, POST, etc.)
Name and Complete Address of Licensing Agency ________________________________________________________
Type of License ____________________________________________________________________________________
Endorsement/Restriction (if applicable) __________________________ Date Licensed ___________________________
SPECIAL SKILLS (Check the skills you possess. Specify speed/errors where requested.)
Typing ____/____ 10 Code ( ) Accident Investigation ( ) Legal Terminology ( ) Medical Terminology ( ) Photo Skills ( )
Computer Software _________________________________________________________________________________
Computer Languages ________________________________________________________________________________
Other ____________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
CRIMINAL CONVICTIONS (List any criminal convictions you have had as an adult.)
EQUIPMENT (List types of equipment you can operate and specify name or model you have used such as radio
equipment, computers, video equipment, alcohol consumption testing equipment, etc.)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
STANDARD APPLICATION 2 Revised 12/2008
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EXPERIENCE
Begin with your present or most recent job and list your work experience with emphasis on experience that is relevant to
the position for which you are applying. Include military service and any volunteer work experience that would help you
qualify. List each promotion as a separate position. You may respond to this section on a separate sheet of paper provided
you answer all questions in the blocks and follow the same format. On each sheet, write your name and the job title for
which you are applying. This information must be completed even if you submit a resume.
Notice to applicants: Information that you provide on this application is subject to verification. Previous employers may
be contacted as references. Do you want to be informed before we contact your present employer? Yes ( ) No ( )
Name and Address of Employer _______________________________________________________________________
Type of Business ___________________________________________________________________________________
Date Employed_______________________________________________ Average Hours Per Week ________________
Your Job Title _______________________________________________ Full-time ( ) Part-time ( ) Volunteer ( )
Immediate Supervisor(s) _______________________________________ Phone Number_________________________
Describe your duties in detail (knowledge, skills, abilities required, employees supervised and accomplishments)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Reason for Leaving _________________________________________________________________________________
Name and Address of Employer _______________________________________________________________________
Type of Business ___________________________________________________________________________________
Date Employed_______________________________________________ Average Hours Per Week ________________
Your Job Title _______________________________________________ Full-time ( ) Part-time ( ) Volunteer ( )
Immediate Supervisor(s) _______________________________________ Phone Number_________________________
Describe your duties in detail (knowledge, skills, abilities required, employees supervised and accomplishments)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Reason for Leaving _________________________________________________________________________________
STANDARD APPLICATION 3 Revised 12/2008
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ADDITIONAL EMPLOYMENT EXPERIENCE
Name and Address of Employer _______________________________________________________________________
Type of Business ___________________________________________________________________________________
Date Employed_______________________________________________ Average Hours Per Week ________________
Your Job Title _______________________________________________ Full-time ( ) Part-time ( ) Volunteer ( )
Immediate Supervisor(s) _______________________________________ Phone Number_________________________
Describe your duties in detail (knowledge, skills, abilities required, employees supervised and accomplishments)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Reason for Leaving _________________________________________________________________________________
Name and Address of Employer _______________________________________________________________________
Type of Business ___________________________________________________________________________________
Date Employed_______________________________________________ Average Hours Per Week ________________
Your Job Title _______________________________________________ Full-time ( ) Part-time ( ) Volunteer ( )
Immediate Supervisor(s) _______________________________________ Phone Number_________________________
Describe your duties in detail (knowledge, skills, abilities required, employees supervised and accomplishments)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Reason for Leaving _________________________________________________________________________________
Name and Address of Employer _______________________________________________________________________
Type of Business ___________________________________________________________________________________
Date Employed_______________________________________________ Average Hours Per Week ________________
Your Job Title _______________________________________________ Full-time ( ) Part-time ( ) Volunteer ( )
Immediate Supervisor(s) _______________________________________ Phone Number_________________________
Describe your duties in detail (knowledge, skills, abilities required, employees supervised and accomplishments)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Reason for Leaving _________________________________________________________________________________
STANDARD APPLICATION 4 Revised 12/2008
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EMPL OYMEN T PREFEREN CE FORM
EMPL OYMEN T PREFEREN CE FORM
Name _____________________________________________ Social Security Number __________________________
Job Title _________________________ Position No.________________Department Name _______________________
To claim preference under the Veterans’ Public Employment Preference Act or the Persons with Disabilities Public
Employment Preference Act, complete the following. Providing the following information is voluntary but must be
included with the application in order to claim employment preference. This information will be kept confidential and will
only be used during the hiring process to apply employment preference. Applicants hired by the state will have this
information placed in a separate confidential selection file. Contact your local Job Service for details on veterans’
preference. Contact your local Montana Vocational Rehabilitation Services Office, Department of Public Health and
Human Services (PHHS) for details on obtaining persons with disabilities preference certification.
1. To claim Veterans’ Employment Preference you must be a U.S. Citizen and (check one of the boxes below):
( ) A Veteran, if
1. You have been separated under honorable conditions, AND have served more than 180 consecutive days of active
federal military duty other than for training in the Army, Air Force, Navy, Marines, or Coast Guard or were a
member of the reserves who served on federal military duty during a period of war or in a campaign or expedition
for which a campaign badge is authorized.
2. You are or have been a member of the Montana Army or Air National Guard who has satisfactorily completed a
minimum of 6 years service in armed forces, the last 3 of which have been served in the Montana Army or Air
National Guard.
( ) A Disabled Veteran, if
1. You have been separated under honorable conditions from military duty, AND
2. You have an established Armed Forces service-connected disability OR are receiving compensation, disability
retirement benefits, or pension from the U.S. Department of Veterans Affairs or military department, OR you
have received a Purple Heart.
( ) The spouse of a disabled veteran if the veteran’s disability prevents him/her from working.
( ) The unremarried surviving spouse of a veteran or disabled veteran.
( ) The mother of a veteran, if
1. THE VETERAN died under honorable conditions while serving in the Armed Forces, OR THE VETERAN has a
service-connected, permanent, and total disability, AND
2. YOUR SPOUSE is totally and permanently disabled, OR YOU are the unremarried widow of the father of the
veteran.
2. To claim Montana Persons with Disabilities Employment Preference you must be (check one of the boxes below):
( ) A person with a disability certified by DPHHS, OR
( ) The spouse of a totally (100%) disabled person certified by PHHS AND have resided continuously in Montana for at
least 1 year immediately before applying for employment.
3. In the box below, check the attachment you have included to document your eligibility for employment
preference.
( ) DD-214 showing the character of discharge ( ) Service-connected disability letter ( ) DPHHS Disability Certification
( ) A document issued by the office of the adjutant General of the Montana National Guard certifying service.
SIGNATURE (typed or written) _____________________________________DATE SIGNED ____________________
STANDARD APPLICATION 5 Revised 12/2008