Mills Police Department Online Application

INSTRUCTIONS: Answer all of the questions. If something does not apply, put N/A. After you have finished filling out the form, click on "submit", one time. After submitting your application, just close the application browser window. When a position becomes available, we may contact you for further information & documentation. By submitting this form you are certifying that the answers given herein are true and complete to the best of your knowledge; and you authorize the investigation of all statements contained in this application as may be necessary in arriving at an employment decision.

The Town of Mills considers applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. Thank you for your interest in the Mills Police Department.

First Name: Middle Name: Last Name:

Date of Birth: Phone Number:

Physical Address: City: State: Zip:

Mailing Address: City: State: Zip:

Do you have a relative employed by the Town of Mills: Select Yes No If yes, whom:

Have you been convicted of a felony? Select Yes No

Have you been convicted or a crime that excludes you from carrying a firearm? Select Yes No

Do You Have a High School Diploma or Equivalent? Select Yes No

Any Prior Law Enforcement Experience? Select Yes No Years:

Any Military Experience? Select Yes No Type of Discharge:

College Education? Select Yes No Years: Select N/A 1 2 3 4 5 6

Is there any reason you cannot perform the functions of the position for which you are applying? Select Yes No

Current or Last

Duties & Responsibilities:

Reason for Leaving:

If presently employed, may we contact above? Select Yes No

Previous

Duties & Responsibilities:

Reason for Leaving:

If presently employed, may we contact above? Select Yes No

Previous

Duties & Responsibilities:

Reason for Leaving:

If presently employed, may we contact above? Select Yes No

Driver's License Number:

Has your driver's license ever been suspended or revoked? Select Yes No

List any accidents or moving violations incurred during the past 36 months.

I understand that my insurability will be verified and I may not be eligible for employment in a driving essential position or, if employed, I may be terminated because I am uninsurable.