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Police Officer

Obetz Police Department · Obetz, OH

Dear Applicant: Thank you for your interest in becoming part of the Obetz Police Department. This packet contains the documents you will need to apply for a Police Officer position with Obetz Police Department. These documents include: a job description; a copy of the Potential Disqualifiers; Personal History Questionnaire; and Authorization for Release of Records.

About you

Before you start

This personal history questionnaire is used by the Obetz Police Department background investigation section. Any failure to provide truthful information will result in rejection for appointment and/or discharge after employment. The use or attempted use of political influence to change employment standards will result in rejection or discharge. All information is subject to verification. Warning: the Ohio Revised Code provides penalties for making a false statement of a material fact or practicing fraud or deception in obtaining municipal employment, including rejection, discharge and/or prosecution under ORC 2921.13. Questions: Chief J. Michael Confer, (614) 409-4411, [email protected].

Section I — Applicant

Personal and marital record.

Maiden or former married names, aliases, nicknames. Enter None if none.
Number and street, apartment or lot number, city, state and ZIP code.
Only if you have lived in Ohio for less than 10 years: street, city, state, ZIP and county of each. Otherwise enter N/A.
For example: Class D, CDL Class A.
Are you a U.S. citizen?
Are you at least 18 years of age?
Are you legally authorized to work in the United States?
Proof will be required upon employment.
Describe each and where it is. Enter None if none. Tattoos are not permitted on the face, head, neck or hands.

Spouse

Enter N/A if not married.
Enter N/A if not married.
Enter N/A if not applicable.

Parents

Natural parents. Enter N/A or Unknown where you do not know an answer.

Number and street, apartment or lot, city, state and ZIP code.
Number and street, apartment or lot, city, state and ZIP code.

Children

For each child: full name; son or daughter; date of birth; relationship to you (natural, step, foster or adoptive); relationship to your spouse (natural, step, foster or adoptive); and address if different from yours. Enter None if none.

Other relatives

List your relatives in this order: 1 brother, 2 sister, 3 stepmother, 4 stepfather, 5 stepbrother, 6 stepsister, 7 father-in-law, 8 mother-in-law, 9 sister-in-law, 10 brother-in-law, 11 ex-spouse.

For each: full name (first, middle, last); date of birth; relationship to you; address if different from yours; phone number.

Section II — Previous residences and references

Indicate all residential addresses for the past 20 years, most recent first, accounting for all time spans. Include all military addresses, listing the nearest city to the base if you lived on base. If renting or leasing, include the agent or management company you paid rent to.

One per line: from (month/year) – to (month/year); full address; who you lived with and their relationship to you; landlord or agent if renting.

References

Three adults who are not related to you and are not former employers, who have known you preferably for more than five years.

Full name; home address and phone; years known; occupation; business address and phone; email.
Full name; home address and phone; years known; occupation; business address and phone; email.
Full name; home address and phone; years known; occupation; business address and phone; email.

Section III — Financial record

1. Are you now supporting all dependents that you are required to support?
2. Are you paying alimony or child support?
In dollars. Enter N/A if you answered No above.
4. Is the amount you pay in child support/alimony in compliance with the court order or an order from a support agency?
If No, explain in detail in the box at the end of this section.
5. Have you ever been sued for alimony payments, child support, nonpayment of debt or fraud?
6. Are you now delinquent, past due, in receipt of late notice, or collection notifications in any financial obligation?
7. Do you, your spouse or ex-spouses have immediate civil action pending against you?
8. If employed by the police department, do you anticipate any income other than your police salary?

Section IV — Work history: law enforcement and government applications

Have you ever applied for a position with any law enforcement or other government agency?

Employment

1. May we contact your present employer?
If No, explain below.
2. Have you ever been discharged or asked to resign from any job?
If yes, make sure the job is listed in your work history below.
3. Have you ever been discharged or asked to resign from a criminal justice occupation?
Most recent first, in chronological order, including part-time jobs, periods of unemployment and military service. For each: from and to dates; total time; reason for leaving; employer name and full address; salary; immediate supervisor; job title; business phone; email; duties. For military, give your last commissioned superior's name, address and rank. For unemployment, write "unemployed" and your source of income.
    If your history doesn't fit above, attach it here.
    PDF, DOC, DOCX, ODT, RTF, TXT, JPG, JPEG, PNG. Up to 10 files, 10.0 MB each. You can select several at once.

    Section V — Military record

    1. Have you ever served in any branch of the military?
    2. Active or Reserve?
    3. Are you registered with the Selective Service System?
    Enter N/A if not applicable.
    Branch; job title (MOS, rate, etc.); military serial number if applicable; total years of service; highest rank achieved. Enter N/A if not applicable.
    4. Have you ever been dishonorably discharged?
    5. Have you ever asked for or received deferment from military service?
    If yes, give board number, dates and full details below.

    Education

    Have you ever taken a General Education Development (GED) test?
    12 = high school, 16 = four-year degree.
    Every elementary, grammar, junior high, intermediate, high school, business, trade school, college or university, most recent first. For each: name; address; dates attended; graduated (yes/no); degree type or credits earned.

    Section VI — Traffic

    For each: date; violation; location of citing agency; your age at the time. Enter None if none.

    Miscellaneous

    You may list any memberships in organized groups or associations that you feel may have a relevant bearing on your ability to perform as a public safety employee, excluding any organization whose name or character indicates the race, color, religion, sex, national origin, handicap, disability, age or ancestry of its members.

    For each: organization (chapter, lodge, etc.); address; relevant activities.

    Section VII — General information inquiry

    The following questions and answers will be verified by the use of a polygraph or voice stress analysis. If the answer to any question is "Yes", explain it in detail in the box at the end of this section. Full and comprehensive explanations are required.

    1. If it became necessary in the course of police duties to take a human life, would you have any reluctance to do so?
    2. Do you have any hatreds or prejudices towards others because of their race, sex, national origin, religion or color that would be detrimental to your ability to function as a public safety employee?
    3. Do you have any problem controlling your temper?
    4. Do you have any problems because of gambling?
    5. As an adult have you ever stolen anything?
    6. Have you ever bought or sold any property that you knew was stolen?
    7. Have you ever been involved in a traffic crash?
    8. Has your driver's license ever been suspended or revoked?
    9. Have you ever used or purchased hallucinogens such as marijuana, hashish, mescaline, P.C.P., T.H.C., Peyote, P.C.E., T.C.P., Angel Dust, or any of their derivatives?
    10. Have you ever used or purchased narcotics such as opium, morphine, codeine, meperidine, methadone, or any of their derivatives such as Darvon, Lomotil, etc. other than for prescribed medical purposes?
    11. Have you ever used or purchased cocaine, heroin, or L.S.D.?
    12. Have you ever used or purchased any prescription drugs such as barbiturates, amphetamines, valium, Librium, spoors, speed, uppers/downers, etc. without the benefit of a prescription?
    13. Have you ever used or purchased any prescribed medications for purposes other than that for which they were originally prescribed or intended?
    14. Have you ever used or purchased what are described as designer drugs (e.g. ecstasy), substances that are chemically altered in make-up but which give the same effect as illicit drugs?
    15. Have you ever sold, been party to the sale, or in any other way been financially rewarded due to the sale of any controlled substance?
    16. Have you ever been involved in the manufacturing, distilling, cultivation, or harvest of illegal or illicit drugs or alcohol?
    17. Have you ever been involved in glue, solvent, paint, refrigerant, or other vapor or chemical sniffing or inhaling for the purpose of obtaining a high or state of intoxication?
    18. Have you ever engaged in any grossly unnatural sex acts or illegal sexual activities?
    19. Have you ever exposed your genitals in public?
    20. As an adult have you ever had sex with a minor?
    21. Have you ever received welfare, workers compensation, unemployment compensation, or other public assistance illegally, or above the amount you were entitled?
    Give the question number for each. Full and comprehensive explanations are required.

    Section VIII — Continuation

    Use this to explain or add to any answer. Refer to the section and question number before each answer.

      PDF, DOC, DOCX, ODT, RTF, TXT, JPG, JPEG, PNG. Up to 10 files, 10.0 MB each. You can select several at once.

      Supporting Documentation

      Please upload your supporting documents required for employment.

        Driver's License, Birth Certificate, High School Diploma or GED, DD214, College Diploma (if applicable), Any Law Enforcement Certifications Currently Held.
        PDF, DOC, DOCX, ODT, RTF, TXT, JPG, JPEG, PNG. Up to 10 files, 10.0 MB each. You can select several at once.

        Authorization to release records

        I understand that investigative inquiries into my background are to be made to assess whether any reason exists that would suggest that I not be accepted for the position(s) stated above. These inquiries will be made according to the Village of Obetz' policies and will consist of a criminal history background check and/or driving record check and/or confirmation of past education and employment. The information received will be kept confidential and will be used only to determine my suitability for the above noted position(s). I authorize without reservation, any party contacted to furnish any or all information related to my criminal history, driving record history, and past education and employment records. Further, I will allow a photocopy of this authorization to be as valid as the original for purposes of conducting the necessary investigation. The name, date of birth, address, phone, years in Ohio, previous residences, position and driver's license you gave above form part of this authorization.

        Type your full name. Typing it here is your electronic signature.
        Signing here has the same effect as signing on paper. The date, time and your IP address are recorded with it.

        Certification

        I certify that the statements contained in this questionnaire are true to the best of my knowledge. I understand that any false statements made in this questionnaire may be cause for disapproval of any appointment or for discharge after my appointment. I further realize that any falsehoods may result in prosecution under Ohio Revised Code Section 2921.13.

        Type your full name. Typing it here is your electronic signature.
        Signing here has the same effect as signing on paper. The date, time and your IP address are recorded with it.

        We use your details only to process this application. Fields marked * are required.