Columbus Police Department

COLUMBUS POLICE DEPARTMENT

Recruiting Office

510 10th Street

Columbus, GA 31902

An Equal Opportunity Employer

APPLICATION & BACKGROUND BOOKLET

NAME ______

(LAST)(FIRST) (MIDDLE)

REFERENCE # ______

(FOR DEPARTMENT USE)

READ ALL INSTRUCTIONS ON THIS PAGE BEFORE PROCEEDING

Failure to follow instructions, providing incomplete or incorrect information will delay or may disqualify you from the hiring process.

Local applicants are required to submit their application in person. Out of town applicants may mail their applications and supporting documentation to the Recruiting Office of the Columbus Police Department. Once your application is received, a background investigator will contact you with further information and instructions.
When submitting your application in person you should allow one (1) hour for the completion of the entire procedure. Applications are accepted Monday – Friday between 8:30 A.M. and 4:00 P.M. Please do not bring children with you to the office.
The applicant must print or type the answers in this booklet legibly in black ink.
All supporting documentation must be clear and legible.
Complete and accurate address and contact information must be given in all requested areas. Incomplete information will delay your process.
All yes/no questions must be answered with either a “Yes” or “No” response. “N/A” stands for “Not Applicable”. Do not use “N/A” when “No” or “None” is the correct response. Do not leave any blanks. Answer all questions accurately, truthfully and in complete detail. There are additional pages in the back of this booklet if needed.
All waivers/forms located in this booklet must be completed prior to submitting your application.
If after submitting this booklet there are any changes to your contact information, you must contact the Recruiting Office promptly.
If at anytime during the application process you are involved in an accident, issued a traffic citation, have criminal or civil charges brought against you, or become part of a criminal investigation, you should contact your background investigator promptly.
If you have any questions contact the Recruiting Office at 706-653-3154.

It is necessary that all information be complete, truthful and accurate. Georgia Peace Officers Standards and Training (P.O.S.T) council, chapter 464-4.12: “The council shall deny certification to any applicant supplying false information or the use of fraud in securing employment. Discovery of deliberate omissions, intentional misrepresentations, or any falsified information will be basis for the termination of the application process or employment and could result in criminal prosecution under Georgia Law Section 16-10-20.

It is imperative any conviction be listed in a criminal proceeding, regardless of whether the judgment of guilt or sentence is withheld or not entered thereon, this includes first offender status. All information will be subject to verification through polygraph and administrative investigation.

I understand the above instructions. I also understand that if I do not wish to answer a question in this booklet, I may not choose to do so and my application will be terminated.

______

(SIGNATURE) (DATE)

APPLICATION PROCESS

APPLICANT DISQUALIFICATIONS

The following conditions shall result in the immediate disqualification of an applicant from consideration in the hiring process for police officer:

Any adult conviction of a felony. Juvenile adjudications will be reviewed on a case by case basis.
Dishonorable discharge from any branch of the armed services.
Any adult conviction, misdemeanor or city ordinance, involving family violence. Juvenile adjudications will be reviewed on a case by case basis.
Any disclosure involving the sale or distribution of an illegal substance shall be reviewed on a case by case basis.
Use of Marijuana within two (2) years of the date of application.
Use of any Schedule II, III, IV or V Narcotics within five (5) years of the date of application.
Use of any prescription medication not used as prescribed or intended will be reviewed on a case by case basis.
Any use of a Schedule I narcotic (Ecstasy, Heroin, GHB, LSD) within ten (10) years of the date of application. Prior use will be determined on a case-by-case basis.
Any illegal use of steroids within three (3) years of the date of application.
All Misdemeanor and City Ordinance convictions not included in the above categories will be reviewed on a case by case basis.
Making any false statements or knowingly providing false information on the application or any document related to the application process.

WE NEED CLEAR COPIES OF THE FOLLOWING DOCUMENTS:

1.Copy of your Birth Certificate.

2.Copy of your High School Diploma or GED.

3.ALL High School Transcripts must be mailed to our office from the high school by U.S. mail. No exceptions.

4.College Diploma(s) (if applicable).

5.ALL College Transcripts must be mailed to our office from the college by U.S. mail. No exceptions.

6.Copy of your DD214 (if applicable). Any discharge other than “Honorable” will require a separate statement that must be signed, witnessed and notarized.

7.A copy of your Valid Driver’s License and Social Security

8.Record of any legal name change (excluding marriage). We will also need court documentation.

9.An Original and Certified ten (10) year driver’s history from ALL the states in which you have been issued a driver’s license within the last 10 years, except for Georgia. You must check with that state for their procedure to obtain your driver’s history.

10.Separate statement(s) for any arrest(s) or military disciplinary action(s) must be signed, witnessed and notarized. We will also need court related documentation and all police reports relating to the incident(s).

INTERNATIONAL HIGH SCHOOL OR COLLEGE DIPLOMAS

All international transcripts and diplomas must be evaluated by an approved evaluation service and sent directly to the Columbus Police Department. This is the applicant’s responsibility.

The following agencies are approved and recommended for diploma and transcript evaluations:

Josef Silny & Associates, Inc.

7101 SW 102 Avenue

Miami, FL 33173

Telephone: (305) 273-1616

Fax: (305) 273-1338

E-mail:

Lisano International

P.O. Box 404

Auburn, AL 36831-0407

Telephone: (334) 745-0425

E-mail:

World Education Service

Bowling Green Station

P.O. Box 5087

New York, NY 10274-5087

Telephone: (212) 966-6311

E-mail:

P.O. Box 1866. 510 Tenth Street

Columbus, Georgia 31902-1866

Recruiting Office

Phone: 706-653-3154Fax: 706-653-3171

DECLARATION

I hereby certify that there are no willful misrepresentations or falsifications in the foregoing statements and answers to questions. I am aware that should investigation disclose any such misrepresentations or falsifications, my application will be rejected, or if already employed, my employment may be terminated. I also understand that a failure to answer each question will cause my application to be disqualified.

______

Signature of ApplicantSignature of Recruiter

______

DateDate

***UPON SUBMISSION THE APPLICANT AND THE RECRUITER WILL REVIEW THE APPLICATION. ONCE THE APPLICATION HAS BEEN REVIEWED AND DEEMED COMPLETE, THE APPLICANT WILL SIGN AND DATE THIS FORM INDICATING THAT ALL INFORMATION PROVIDED IS TRUE AND CORRECT. THE RECRUITER WILL SIGN AND DATE THIS FORM AS A WITNESS.

P.O. Box 1866. 510 Tenth Street

Columbus, Georgia 31902-1866

Recruiting Office

Phone: 706-653-3154Fax: 706-653-3171

TO WHOM IT MAY CONCERN

I, ______, having submitted an application to the Columbus Police Department for the position of Police Officer, agree to participate in all phases of the applicant screening process to determine my suitability for employment.

I fully understand that a Physical Qualifications Test is required and that my participation in said test is a personal choice. In doing so, I hereby relieve the Columbus Police Department, Columbus Consolidated Government, and their representatives of any and all liability for personal harm or injury resulting from my participation.

Signed: ______Date: ______

Witness: ______Date: ______

Notary Signature: ______

My Commission Expires: ______

(Stamp Only – Not Hand Written)

Notary Seal:

P.O. Box 1866. 510 Tenth Street

Columbus, Georgia 31902-1866

Recruiting Office

AUTHORITY TO RELEASE INFORMATION

TO WHOM ITMAY CONCERN:

I hereby authorize any Officer or other authorized representative of the Columbus Police Department bearing this release, or copy thereof, within one year of its date, to obtain any information in your files pertaining to my military or employment history and educational records (including, but not limited to: academic, achievement, attendance, athletic, personal history and disciplinary records); medical records; and credit records. Further authorization is extended to all Police Departments, Sheriff's Departments, Juvenile Courts and Clerks of Courts, to furnish the bearer with information, reprints, photographs and any other record containing information relating to criminal history or activity.

I hereby direct you to release such information upon request of bearer. I hereby release you, as the custodian of such records, and any employer, school, college, university, or other educational institution, hospital, or other repository of medical records, credit bureau of consumer reporting agency, including its officers, employees or related personnel (both individually and collectively) from any and all liability for damages of whatever kind, which may at any time result to me, my heirs, family or associates because of compliance with this authorization and request to release information, or any attempt to comply with it.

I further authorize the acceptance of a copy of this original to be used as authorization to release any and all information in lieu of the original which remains on file with this investigating agency. Should there be any questions as to the validity of this release, you may contact me as indicated below.

Full Name: ______FullName: ______

(Printed) (Signature)

Date of Birth: ______Social Security Number: ______

Current Address:

______Telephone Number: ______

Witness: ______Date: ______

Notary Public: ______

My Commission Expires: ______

(Stamp Only – Not Hand Written)

Notary Seal:

PERSONAL DATA

1. NAME ______

(FIRST) (MIDDLE)(LAST)

D.O.B ______SSN ______

(MONTH/DAY/YEAR)

GIVE ANY OTHER NAMES YOU HAVE USED OR BEEN KNOWN BY AND GIVE REASONS FOR THOSE NAMES. IF NONE, STATE “NONE”.

______

2. RACE_____ SEX_____ HEIGHT_____ WEIGHT_____ HAIR_____ EYES_____

3. LIST ANY SCARS MARKS OR TATTOOS ______

4. NATURAL BORN CITIZEN [ ] OR NATURALIZED [ ]

CERTIFICATE # / COUNTRY ______

5. LOCATION OF BIRTH ______

(IF NATURAL BORN) (CITY) (STATE) (COUNTY)

6. YOUR MAILING ADDRESS (DO NOT USE A P.O. BOX) ______

7. HOME PHONE ______ALTERNATE PHONE ______

E-MAIL ADDRESS ______

8. WITH WHOM DO YOU RESIDE ______

(FULL NAME)

9. LIST ALL ORGANIZATIONS, CLUBS AND ASSOCIATIONS WHICH YOU ARE OR HAVE BEEN A MEMBER OF OR ASSOCIATED WITH ______

10. WHAT ARE YOUR HOBBIES, SPECIAL SKILLS AND ABILITIES (INCLUDE SPEAKING ANY FOREIGN LANGUAGES) ______

MARITAL INFORMATION

1. IF YOU ARE MARRIED, SEPARATED OR DIVORCED, COMPLETE THE FOLLOWING INFORMATION ABOUT YOUR CURRENT SPOUSE AS WELL AS ANY FORMER SPOUSE(S). IF YOU NEED MORE SPACE, USE THE ADDITIONAL PAGES IN THE BACK OF THIS PACKET.

CHECK ANY/ALL BOXES THAT APPLY:

SINGLE [ ] MARRIED [ ] WIDOWED [ ]

SEPARATED [ ] DIVORCED [ ]

NAME ______

(FIRST) (MIDDLE) (MAIDEN – IF APPLICABLE)

PHONE NUMBER ______

OCCUPATION & EMPLOYER ______

DATE MARRIED ______DATE SEPARATED / DIVORCED ______

FAMILY INFORMATION

2. LIST ALL OF YOUR DEPENDENTS (EXCLUDE CURRENT SPOUSE)

NAMEDATE OF BIRTHRELATIONSHIP

3. LIST ALL LIVING MEMBERS OF YOUR IMMEDIATE FAMILY. INCLUDE FATHER, MOTHER, SIBLINGS, MOTHER-IN-LAW AND FATHER-IN-LAW.

NAMERELATIONSHIPCITY/STPHONE #

RESIDENCES

LIST ALL RESIDENCES YOU HAVE LIVED IN THE LAST TEN (10) YEARS. THIS SHOULD INCLUDE TEMPORARY ADDRESSES, PART-TIME ADDRESSES, MILITARY ADDRESSES, PERMANENT ADDRESSES, AND SCHOOL ADDRESSES. START WITH YOUR CURRENT ADDRESS.

FROM / TO / STREET # / STREET NAME / CITY / ST / ZIP / COUNTY

EDUCATION

1. IF YOU GRADUATED HIGH SCHOOL, COMPLETE THE FOLLOWING

______

(NAME OF SCHOOL)(DATES ATTENDED)

______

(ADDRESS) (CITY, STATE) (ZIP)

______

(PHONE NUMBER)(DATE GRADUATED)

2. IF YOU OBTAINED A G.E.D CERTIFICATE, COMPLETE THE FOLLOWING

______

(NAME OF SCHOOL/ORGANIZATION)(DATES ATTENDED)

______

(ADDRESS) (CITY, STATE) (ZIP)

______

(STATE G.E.D. OBTAINED) (DATE OBTAINED)

3. HAVE YOU EVER BEEN EXPELLED, SUSPENDED OR DISCIPLINED BY A SCHOOL OFFICIAL? IF YES, EXPLAIN.

4. LIST BELOW ANY COLLEGES, UNIVERSITIES, TECHNICAL OR GRADUATE SCHOOLS YOU HAVE ATTENDED.

SCHOOL ATTENDED / CITY / STATE / DATE FROM / DATE TO / AREA OF STUDY / DEGREE OBTAINED

OTHER LAW ENFORCEMENT APPLICATIONS / CERTIFICATIONS

1. LIST ALL OTHER LAW ENFORCEMENT AGENCIES WITH WHICH YOU HAVE APPLIED FOR EMPLOYMENT. INCLUDE CONTACT INFORMATION.

AGENCY / PHONE # / CITY / STATE / DATE APPLIED / STATUS OF APPLICATION

2. LIST ANY LAW ENFORCEMENT ACADEMIES YOU HAVE ATTENDED.

ACADEMY / CITY / STATE / DATES ATTENDED / CERTIFICATION #

EMPLOYMENT HISTORY

LIST IN DESCENDING ORDER ALL EMPLOYMENT FOR THE LAST TEN (10) YEARS TO INCLUDE: CURRENT, PART-TIME, SEASONAL/TEMPORARY AND VOLUNTEER. PLEASE PROVIDE ALL INFORMATION AS IT IS REQUESTED BELOW. FAILURE TO PROVIDE COMPLETE AND CORRECT INFORMATION WILL DELAY THE BACKGROUND PROCESS.