DJ-LE-330: Application for Employment, Law Enforcement, Jail or Secure Juvenile Detention Officer

Enter Name (Last, First, Middle), Address (Apartment, Street, P.O. Box), City, State, Zip Code, Home Telephone Number, Work Telephone Number, Cell Phone Number and Email Address.

Have you successfully completed the basic training required for certification (i.e. 720-hour law enforcement academy)? Yes No

If yes, mark the type(s) of basic training you have successfully completed: Law Enforcement, Jail or Secure Juvenile Detention.

If applicable, include the name of the school where you completed basic training and the date that training was completed.

Mark Yes or No for each: Are you at least 18 years old? Are you a United States citizen? Do you have a high school diploma, GED or HSED?

Mark Yes or No: Do you have an Associate Degree or 60 associate degree level credits or higher from an accredited college or university? If No, were you employed as a law enforcement officer prior to February 1, 1993? The college credit requirement as written in Wisconsin Administrative Code § LES 2.01(1)(e), pertains to law enforcement and tribal law enforcement officers first employed on or after February 1, 1993.

Mark Yes or No for each: Have you ever been convicted of a felony? Have you ever been convicted of a misdemeanor crime of domestic violence? Are you prohibited by state or federal law from possessing a firearm? Do you possess a valid Wisconsin driver's license or a valid driver's license from another state?

For High School(s) and College(s), enter Name of School(s), Dates From (mm/yyyy) To (mm/yyyy) and Degree, Diploma, or Credits Earned.

Begin with current or most recent employer.

List chronologically all employment, including summer and part-time employment while attending school.

To furnish additional employment information, attach sheets of the same size and format as this application.

Enter Name of Employer, Address, City, State, Zip Code, Dates of Employment From (mm/yyyy) To (mm/yyyy), Full-Time or Part-Time, Annual Salary/Wages, Supervisor's Name / Telephone Number, Position and kind of work and Reason for Leaving.

Enter Branch of Service, From (mm/yyyy), To (mm/yyyy), Active Duty or Reserve, Highest Grade and Skill Specialty or Primary Duty. Honorably Discharged from Military Service? Yes No Not Applicable

Give three references (not relatives, or present employer; avoid listing members of the clergy). Enter Name, Position/Title/Profession, Number of Years Acquainted, Address, City/State/Zip and Telephone Number.

Applicant, read carefully and sign. Enter Applicants Signature and Date Signed.

The certification states that all information provided and statements made by the applicant as part of this application, or as part of any additional information provided in support of this application, are complete, correct, and true to the best of the applicant's knowledge. If the applicant is employed, false information provided or false statements made as part of this application may be considered as cause for dismissal.

Under the provisions of § 19.36, Wis. Stats., the applicant requests that the applicant's identity as an applicant for this position not be revealed without the applicant's consent or until required under law. Also enter Applicants Signature and Date Signed.

Complete if instructed to do so by the employing agency. Attach no more than one additional page for each answer.

A. Why have you chosen to apply for this position?

B. Discuss things you have done which have contributed to your life experience. Be sure to include information regarding volunteer work with civic, school, or professional organizations. Be specific about names and dates.

C. Why do you believe you can relate to and/or work with people of different races, genders, cultures, ages, socio-economic groups, and educational levels?