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Application for-employment

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Application for-employment

  1. 1. 1 DJ-LE-330, Rev. 8/00 UWMPD revisions 11/05 University of Wisconsin-Milwaukee Police Department 3410 North Maryland Avenue Milwaukee, WI 53211 APPLICATION FOR EMPLOYMENT Position Applying for: _______________________________ Date: _________________________________ NOTICE: Application must be typewritten or clearly printed in ink. All questions must be answered, if applicable. If not, indicate NA (not applicable). Applications which are incomplete or illegible will not be considered. If space provided is insufficient for complete answers or you wish to furnish additional information, attach sheets of the same size as this application and number answers to correspond with questions. 1. PERSONAL INFORMATION Name in Full (Last, First, Middle) Date of Birth Social Security Number Address (Apartment, Street, P.O. Box) Home Telephone Number ( ) City State Zip Code Work Telephone Number ( ) Are you over the age of 18? Yes No Do you have a valid Wisconsin driver's license? Yes No Have you ever been convicted of a felony? Yes No If yes, please attach a separate sheet giving full information? Are you a United States citizen? Yes No Do you have a valid driver's license from another state? Yes No Have you completed at least 60 college credits? Yes No IMPORTANT: Administrative Rule LES 2.01(1)(e) requires that an applicant possess either a two-year Associate Degree or 60 college level credits, or meet the standard within the first five years of employment. The Law Enforcement Standards Board may waive up to 30 credits upon documentation of writing, problem solving, and other communication skills. [Waiver forms available via the Department of Justice, Training and Standards Bureau, P.O. Box 7070, Madison, WI 53707-7070, 608/266-8800.] 2. EDUCATION Dates Name of School Location From To Course Pursued Degree, Diploma, or Credits Earned High Schools College Graduate School List any scholarships, apprenticeships, licenses, certifications, membership in professional organizations or other information you believe should be considered in evaluating your qualifications.
  2. 2. 2 3. EMPLOYMENT Begin with current or most recent employer. List chronologically all employment, including summer and part-time employment while attending school. All time must be accounted for. If unemployed for a period, provide dates. To furnish additional employment information, attach sheets of the same size and format as this application. Name and Address of Employer Dates Position and Kind of Work Name Street City, State Supervisor's Name/Telephone: May we contact the employer/supervisor? Yes No From To Full-Time Part-Time Annual Salary/Wages: Reason for Leaving Name Street City, State Supervisor's Name/Telephone: May we contact the employer/supervisor? Yes No From To Full-Time Part-Time Annual Salary/Wages: Reason for Leaving Name Street City, State Supervisor's Name/Telephone: May we contact the employer/supervisor? Yes No From To Full-Time Part-Time Annual Salary/Wages: Reason for Leaving Name Street City, State Supervisor's Name/Telephone: May we contact the employer/supervisor? Yes No From To Full-Time Part-Time Annual Salary/Wages: Reason for Leaving
  3. 3. 3 4. MILITARY SERVICE Branch of Service Month/Year Served From To Active Duty or Reserve Highest Grade Skill Specialty or Primary Duty List special schools attended/skills acquired during military service. 5. REFERENCES Give three references (not relatives, or present employer; avoid listing members of the clergy). Name Number of Years Acquainted Address City/State/Zip Telephone Number ( ) Position/Title/Profession Name Number of Years Acquainted Address City/State/Zip Telephone Number ( ) Position/Title/Profession Name Number of Years Acquainted Address City/State/Zip Telephone Number ( ) Position/Title/Profession 6. GENERAL COMPLETE IF INSTRUCTED TO DO SO BY EMPLOYING AGENCY. For questions A-C, 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. Remember to include information regarding volunteer work with civic, school, or professional organizations. Be specific about names and dates. C. Why do you believe you could relate to and/or work with people of different races, sexes, cultures, ages, socio-economic groups, and educational levels?
  4. 4. 4 APPLICANT PLEASE READ CAREFULLY AND SIGN BELOW Information provided and statements made as part of this application may be grounds for not employing you or for dismissing you after you begin work. All information provided and statements made are subject to verification. CERTIFICATION ALL INFORMATION PROVIDED AND STATEMENTS MADE BY ME 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 MY KNOWLEDGE. I UNDERSTAND THAT IF I AM EMPLOYED, FALSE INFORMATION PROVIDED OR FALSE STATEMENTS MADE AS PART OF THIS APPLICATION MAY BE CONSIDERED AS CAUSE FOR DISMISSAL. Applicant's signature: Date signed: Under the provisions of section 19.36, Wisconsin Statutes, I request that my identity as an applicant for the position of not be revealed without my consent or until required under law. Applicant's signature: Date signed:
  5. 5. 5 APPLICANT CONSENT AND DISCLOSURE FORM University of Wisconsin-Milwaukee NOTE TO APPLICANT: The position you have applied for requires candidates to pass a criminal background check as a condition of employment. This includes a review of any pending charges or convictions. The Wisconsin Fair Employment Act prevents employers from disqualifying applicants based on criminal history unless the position being applied for has job responsibilities that are substantially related to the criminal history. To facilitate this process, please complete this form and return it sealed in the attached envelope. The information requested below is required for the sole purpose of accurately gathering information needed for the criminal background check and will not be used for any other purpose. A record of conviction and/or pending criminal charges may not, in and of itself, disqualify you from employment at UWM. Such information will be considered only if there is a substantial relationship between the circumstances of the conviction and/or pending charge and the position being applied for. Failure to disclose required information, or any misrepresentation made in connection with such disclosure, may affect the UWM's decision to hire and/or discipline up to and including discharge. To be completed by the applicant (Please print). Submit directly to School/College/Division Personnel Rep. Name: Gender: Female _____ Male ______First Middle Last Other names you have used in the past (including maiden name): Birthdate: Social Security Number(s): (mm/dd/yyyy) Current Address: (street, city, state and ZIP required): Previous Address: (street, city, state and ZIP required – Use back of this sheet for additional addresses covering the last 7 years): Have you ever been convicted of, or pleaded ‘no contest’ to, a felony or misdemeanor?  No  Yes (provide details on next page) Do you have any charges for felony or misdemeanor pending against you?  No  Yes (provide details on next page) If you answered Yes to either or both questions above, please provide details on next page (Use additional sheet(s), if necessary). Name: To be completed by hiring department (Please print): (DO NOT VIEW APPLICANT ENTRIES) School/College/Div.: University of Wisconsin – Milwaukee Department: UW-Milwaukee Police Dept. Recruitment Number: Position Number: Title: Type of appointment (check one):  Faculty  Academic Staff  Classified  LTE  Adjunct AS  Student  Other  Limited Appointment LI Driving record check required?  Yes  No PREP to notify: Billing Code: Submitted by: (PREPs only): Email/phone: Send report to: Email/phone:
  6. 6. 6 First Middle Last Have you resided in the United States for the last seven years?  No  Yes Nature of offense(s)/charge(s): Date(s) of conviction(s)/charge(s): Location of court (s): (for additional information/space, use additional sheets) The information I have provided on this form is true and correct. I understand that if the University of Wisconsin--Milwaukee receives information at a later date that shows I did not accurately disclose all convictions and pending charges, I may be disqualified from this position, or if already hired, subject to discipline up to and including discharge. I hereby authorize the University of Wisconsin-Milwaukee (UWM) to obtain criminal and other records about me from any source for the purpose of evaluating my employability for the position I have applied for. I also authorize UWM to provide such records to third parties for the same purpose. Such third parties and the Board of Regents of the University of Wisconsin System, its agents, employees, and officers, including UWM, are hereby released of any liability that may arise from the disclosure of such information. I have read and understand the above authorization and release. Signature (do not print or type) Date Please sign and date form and all attachments. _____________________________________________ Return directly to the School/College/Division Email and telephone number Personnel Rep only. California, Minnesota or Oklahoma Applicants only – You will be provided with a free copy of any consumer reports or investigative reports obtained on you if you check the box below.  I wish to receive a free copy of the report

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