OXFORD TOWNSHIP POLICE DEPARTMENT      

                                            APPLICATION FOR EMPLOYMENT

Back to Police

Michael D. Goins   -  Chief of Police

James McDonough - Trustee

Gary Salmon - Trustee

Larry Frimerman - Trustee

Name:__________________________________________________________________

Last First Middle

Address:________________________________________________________________

Street City State Zip

Phone:_________________________________________________________________

Home Work Cell Other

APPLICANTS PERSONAL INFORMATION

Drivers License Number:______________State:_____ Expiration Date:____________

Social Security Number:_______________________ Date of Birth:_________________

Height:_______ Weight:______ Hair:___________ Eyes:_________ Sex:___________

Spouses Name:_____________________________ Number of Dependants:__________

Children:____________________ Age:______ ______________________Age:_____

____________________ Age:______ ______________________Age:_____

____________________ Age:______ ______________________Age:_____

 

APPLICANTS WORK HISTORY

(List only last 6 Employers)

EMPLOYER:____________________________________________________________

ADDRESS: _____________________________________________________________

Street City State Zip Phone

Start Date:____________ End Date:___________ Reason for Leaving:___________________

 

EMPLOYER:____________________________________________________________

ADDRESS: _____________________________________________________________

Street City State Zip Phone

Start Date:____________ End Date:__________ Reason for Leaving:_______________

 

EMPLOYER:____________________________________________________________

ADDRESS: ____________________________________________________________

Street City State Zip Phone

 

Start Date:__________ End Date:__________ Reason for Leaving:_________________

 

EMPLOYER:____________________________________________________________

ADDRESS: ____________________________________________________________

Street City State Zip Phone

Start Date:__________ End Date:_________ Reason for Leaving:__________________

 

 

 

 

 

Continued

EMPLOYER:____________________________________________________________

ADDRESS: ____________________________________________________________

Street City State Zip Phone

 

Start Date:__________ End Date:__________ Reason for Leaving:_________________

 

 

 

EMPLOYER:____________________________________________________________

ADDRESS: ____________________________________________________________

Street City State Zip Phone

 

Start Date:______ End Date:______ Reason for Leaving:______________________

 

 

LAW ENFORCEMENT TRAINING

 

OPOTA CERTIFIED ACADEMY :____________________________________________

ACADEMY CLASS NUMBER:____________________

DATES ATTENDED: _______________ to_______________ Totals:____________

 

SPECIALIZED TRAINING:

 

COURSE:_______________________________ DATE ATTENDED:________________

COURSE: ______________________________ DATE ATTENDED:________________

COURSE: ______________________________ DATE ATTENDED:________________

COURSE: ______________________________ DATE ATTENDED:________________

COURSE:_______________________________ DATE ATTENDED:________________

COURSE:_______________________________ DATE ATTENDED:________________

COURSE:_______________________________ DATE ATTENDED:________________

COURSE: ______________________________ DATE ATTENDED:________________

ADDITIONAL COMMENTS OR TRAINING LIST BELOW

 

APPLICANTS EDUCATION INFORMATION

HIGH SCHOOL

High School Name:_______________________________________________________

Did you graduate?: __________________ GED?:_______________

 

COLLEGE

University Name:_________________________________________________________

Degree:_______________________________ Did you Graduate?:_________________

 

ADDITIONAL SCHOOLS/EDUCATION

Name:__________________________________________________________________

Course/Certification:_______________________________________________________

Completed?:__________________________

 

NAME:_________________________________________________________________

Course/Certification:______________________________________________________

Completed:___________________________

 

NAME:________________________________________________________________

Course/Certification:______________________________________________________

Completed:___________________________

 

 

APPLICANTS BACKGROUND/DISCLOSURE REPORT

Have you ever used illegal Drugs: Yes [ ] No [ ]

Have you ever permitted illegal Drug use: Yes[ ] No [ ]

Have you ever been arrested for a criminal offense: Yes [ ] No [ ]

Have you ever been arrested for a traffic offense: Yes [ ] No [ ]

Have you or do you now have a family member who is

Or has used an illegal Drug(s): Yes [ ] No [ ]

Have you been convicted of a sexual offense: Yes [ ] No [ ]

Have you ever been convicted or charged with a theft Yes [ ] No [ ]

Have you been or are you currently involved in a Civil Action Yes [ ] No [ ]

Have you been charged or arrested for any offense: Yes [ ] No [ ]

PLEASE EXPLAIN ANY "YES" ANSWERS BELOW

 

 

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APPLICANTS REFERENCE'S) OF EMPLOYMENT

 

NAME:__________________________________ Position:_______________________

ADDRESS:______________________________________________________________

Street City State Zip

PHONE:__________________________ Best Time to Contact:____________________

 

 

NAME:__________________________________ Position:_______________________

ADDRESS:______________________________________________________________

Street City State Zip

PHONE:__________________________ Best Time to Contact:____________________

 

NAME:__________________________________ Position:_______________________

ADDRESS:______________________________________________________________

Street City State Zip

PHONE:__________________________ Best Time to Contact:____________________

 

NAME:__________________________________ Position:_______________________

ADDRESS:______________________________________________________________

Street City State Zip

PHONE:__________________________ Best Time to Contact:____________________

 

NAME:__________________________________ Position:_______________________

ADDRESS:______________________________________________________________

Street City State Zip

PHONE:__________________________ Best Time to Contact:____________________

 

 

APPLICANTS BACKGROUND WAVIER

 

I ________________________________ give my permission to the Oxford Township Police Department to do a background check on myself in reference to employment application. I understand that this may be done by computer, writings, and personal contact with references, family, former and current employees. I understand that a home visit to my residence may be made also by an Oxford Township Police Officer. I hereby waive all rights to the use and collection of any and all information obtained that relates to my potential employment.

 

____________________________________

Applicants Signature Date

Sworn to before me and subscribed in my presence in the County of ________________

State of Ohio this____________ day of_________________20_______

 

______________________________

Notary Public-Expiration Date                                     

 

 

 

 

 

All Applicants must pass a Drug Screen, Background Check, CVSA

                                                                Mail to:  Chief Michael D. Goins

                                                      Oxford Township Police Department

                                                                  925 Collins Run Road

                                                                    Oxford, Ohio 45056

 

ATTACH PHOTO OF APPLICANT BELOW