BECKLEY POLICE DEPARTMENT APPLICATION FORM

Applied Before
- Yes
- No
If yes, date:
MM slash DD slash YYYY
The City of Beckley is an Equal Opportunity Employer and considers all applications for employment without regard to race, color, religion, creed, gender, national origin, disability, marital or veteran status, sexual orientation or any other legally protected status. Per WV State law, all applicants must be between 18-40 years of age.

Directions: Please respond to ALL questions. If a particular question does not apply to you or the position for which you area applying, write N/A in the appropriate blank. PLEASE PRINT CLEARLY. An incomplete application will not be considered for employment.
Date of Application
MM slash DD slash YYYY
Position
LET Certified?
- Yes
- No
If Yes, what state?
Date of Birth
MM slash DD slash YYYY
Social Security Number
Name
First Middle Last
Physical Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Mailing Address
Is your mailing address the same as your physical address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
List of previous addresses in the last 10 years
Address City State Zip Code
Phone Number*
Email Address
Have you been employed with Beckley Police Department before?
- Yes
- No
If yes, what date?
MM slash DD slash YYYY
Reason for leaving
Do any of your friends or relatives work for the City?
- Yes
- No
What is their position
Are you able to produce proof of identity and eligibility for employment in the United States?
- Yes
- No
Proof of citizenship will be required upon employment.
Have you ever been convicted of a misdemeanor or felony?
- Yes
- No
If yes, please explain.
Do you have visible tattoos?
- Yes
- No
If yes, please describe.
Are you currently employed?
- Yes
- No
If yes, may we contact your employer?
- Yes
- No
Please list the names of present and previous employers in order, beg inning with the most recent employer. Include periods of military service, self-employment and unemployment.
Employer 1
Date Employed From
MM slash DD slash YYYY
Date Employed To
MM slash DD slash YYYY
Employer 1 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Employer 1 Phone Number
Rate of Pay Starting
How Often
Job Title
Immediate Supervisor
Supervisor Phone Number
Work Performed / Job Duties
Reason for Leaving
High School
Name and address Course of Study Diploma/degree
College
Name and address Course of Study Diploma/degree
Graduate/Professional
Name and address Course of Study Diploma/degree
Business/ Trade School
Name and address Course of Study Diploma/degree
Other - Specify
Name and address Course of Study Diploma/degree
License or Certification (Include Driver’s License)
Type State Date Received Expiration Date Certificate Number
Describe any specialized training, apprenticeship, job-related skills and qualifications acquired from employment or other experience.
List professional, trade, business or civic activities and offices held.
List any additional information, skills (computer) or equipment used that may be applicable to the position you are applying for.
Military
Branch
Rank at Discharge
Type of Discharge
Briefly describe job duties:
***To be eligible for Veteran’s Preference Points an applicant would have to have been enlisted in the Armed Forces after September 7, 1960 or entered active duty other than by enlistment on or after October 14, 1982; AND
a) Completed 24 months continuous active duty or the full period called or ordered to active duty or was discharged under 10 U.S.C. 1171 or for hardship under 10 U.S.C. 1173; AND received or was entitled to receive a campaign badge or expeditionary medal, OR

b) Is a disabled veteran.
Please attach a copy of your DD-214 if you are eligible and requesting Veteran’s Preference Points.
Accepted file types: pdf, jpg, png, Max. file size: 20 MB.
References
Name Phone Number Address Relationship Years Known

You must list at least four (4) references. Do NOT include family members or past supervisors.
I authorize the City of Beckley or its agents to contact by phone, correspondence, or in person, my previous employers and personal references to determine fitness for employment and may include, but is not limited to: employment history verification, job performance, disciplinary record, criminal background investigation, character and reputation. I further acknowledge I will not pursue any legal claims, including, but not limited to, defamation, libel, slander or invasion of privacy against the City of Beckley.

By signing this agreement, I agree to hold harmless any previous employer, or agent of that organization, or any individual providing information in this authorization. I further authorize the City of Beckley to provide a copy of this release upon request.
I have read the information above
- Yes
I hereby affirm with this application of employment as a police officer that the information provided on this application is true and complete to the best of my knowledge and that I am at least 18 years of age and no older than 40 years of age at the present time. I agree that falsified information may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.

I understand that the City reserves the right to require its employees to submit to blood tests or urinalysis for alcohol or drug screens. I understand that refusal to submit to a urinalysis, blood test or search, when requested to do so, may result in termination of my employment.

Compliance with the City of Beckley/Beckley Police Department Substance Abuse/Drug Testing Policy is a condition of employment. The City requires that every newly hired employee be free of alcohol or drug abuse. Each offer of employment is contingent upon successfully compleeting a urinalysis test/screen for alcohol and drugs in accordance with City and Deparmental policy. Continued employment is also contingent upon compliance with the police department’s Drug Testing Policy.

RELEASE:

I hereby authorize any prior employers to provide such information concerning my employment with them as be requested, and also authorize the Registrar/Placement Office of all educational institutions attended to release an official copy of my transcript and, if applicable, faculty appraisals.
I have read and understand these conditions of employment.
I have read the information above
- Yes
Applicant Name
Signature
Date
MM slash DD slash YYYY
 I certify that answers given herein are true and complete to the best of my knowledge.
 I agree if the information is found to be false in any way, it shall be considered sufficient cause for denial of employment or discharge.
 I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
 I understand that this application for employment shall be considered for a period of time not to exceed 2 years. I understand that to be reconsidered for employment after this time I will need to file a new application.
 I understand that I will need to keep the Beckley Police Department advised of any change in address or telephone number while my application is on file.
 I understand that I must have the PHYSICAL AGILITY TEST form signed and notarized and bring it with me on the day of the Physical Agility Test.
 I have read and understand the Beckley Police Department’s AUTOMATIC DISQUALIFIERS FOR POLICE OFFICERS.
 I have read and understand the Beckley Police Department’s Personal Appearance Policy section on TATTOOS/BODY ART/BRANDS.
 I have read and understand the Beckley Police Department’s RESIDENCY REQUIREMENTS.
 All who are appointed to the position of Probationary Police Officer shall be for a probationary period of twelve months: Provided, that at any time during the probationary period the probationer may be discharged, in the manner provided in the WV State Code. If, at the close of this probationary period, the conduct or capacity of the probationer has not been satisfactory to the appointing department, the probationer shall be notified, in writing, that they will not receive absolute appointment, whereupon their employment shall cease; otherwise, their retention in the position of Police Officer beyond the probationary term shall be equivalent to their absolute appointment.
I have read and agree with the information above
- Yes
Signature
Date
MM slash DD slash YYYY

BECKLEY POLICE DEPARTMENT APPLICATION FORM

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Address	City	State	Zip Code

Name and address	Course of Study	Diploma/degree

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