morris police department 400 colorado avenue p.o. box 245 … · 2020. 12. 11. · the city of...

APPLICATION FOR EMPLOYMENT

Morris Police Department400 Colorado AvenueP.O. Box 245Morris, MN 56267 Phone: 320-208-6500 Fax: 320-589-1157 www.ci.morris.mn.us/[email protected]

General InformationPosition Applied For: Available to Work:

□ Full Time □ Part Time □ Seasonal

Date of Application: Date Available for Work: Email Address:

Last Name: First Name: Middle Name:

Street Address: City: State: Zip:

County: Phone Number:

Have you been previously employed by the city?

Yes No If yes, Date__________________ Position____________________________Are you able to legally work in the United States?

Educational Background Education School Name, City, State

High School Diploma □ Yes □ No

Yes □GED No □

College Degree Completed: □ Masters □ AAS

□ Bachelors □ Other:________

College Degree Completed: □ Masters □ AAS

□ Bachelors □ Other:________

Technical/Certificate

Programs

Indicate type of certificate earned:

Yes No

For Police Department Positions Only Are you currently Minnesota P.O.S.T. licensed or eligible for Minnesota P.O.S

Yes, I am currently licensed. Please indicate license # __________________________Expiration _____________

Yes, I am eligible for P.O.S.T. licensing with a test date of _____________________________ from the Minnesota

No, I am not licensed or not currently eligible for licensing.

Major Area of Study

_

_

.T. licensing? (please select one)

______________

P.O.S.T. Board.

2

Employment History- List your present or most recent employer FIRST. List all employment for the past 10 years (use additional sheet if necessary)PRESENT EMPLOYER Employer: Dates Employed:

From: __________________________ To: __________________________

Job Title:

Address:

Telephone: Job Duties:

Pay Information

Starting Rate: Ending Rate:

Reason For Leaving:

May we contact this employer?

PREVIOUS EMPLOYER Employer: Dates Employed:

From: __________________________ To: __________________________

Job Title:

Address:


Pay Information


Reason For Leaving:


2nd

PREVIOUS EMPLOYEREmployer: Dates Employed:

From: __________________________ To: __________________________

Job Title:

Address:


Pay Information


Reason For Leaving:


Yes No If no, Explain: _________________________________



3

3rd


From: __________________________ To: __________________________

Job Title:

Address:


Pay Information


Reason For Leaving:


4th


From: __________________________ To: __________________________

Job Title:

Address:


Pay Information


Reason For Leaving:


5th


From: __________________________ To: __________________________

Job Title:

Address:


Pay Information


Reason For Leaving:


***Please attach sheet with additional work experience if necessary***

Explain any periods of unemployment:

__________________________________________________________________________________________________

Yes No If no, Explain: ________________________________



4

Volunteer Experience Organization: Duties: # of Hours: From: To:

____________________________________________________________________

Applicants Signature Date

Describe any additional experience or training that qualifies you for this job_____________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

IMPORTANT FACTS CONCERNING INFORMATION PROVIDED ON YOUR APPLICATION

You are advised that the information requested on this form will be used for the purposes of determining job qualifications, salary

rates within range and for summary data purposes, and may constitute a public record according to Minnesota Statutes. You are not

legally required to supply the requested information, but the information is necessary in determining your qualifications for the

position for which you have applied. An incomplete application may hinder your employment with the city. All materials submitted

in support of an application are normally retained with the applications and not returned. You should not submit an original document

if it is your only copy.

I understand that any false information on or omission of information from this application, or failure to present the required proofs,

will be caused for rejection or dismissal if employed.

The City of Morris is an Equal Opportunity Employer

Please be advised that in accordance with the Minnesota Uniform Transaction Act, an electronic signature on this document is binding and afforded the same effect as if the document was signed by hand.

5

PROFESSIONAL REFERENCES

Name & Occupation Address Phone Number

6

CERTIFICATION & AUTHORIZATION

1) I authorize the investigation of all statements I enter on my application and certify thatthey are true and correct to the best of my knowledge. I understand that should

investigation disclose material misrepresentation or falsification, my application may be

disqualified, or if employed, my employment and all rights and privileges of my

employment may be immediately terminated.

2) I understand that in order to determine my qualifications for positions I apply for it maybe necessary to investigate my employment history, educational accomplishments,

criminal history, and credit reports. I direct the custodian of these records to release this

information to any authorized agent of the employing organization. I release any

individual, institution, business or organization from any and all liability for damages

which might arise from the release of pertinent information.

3) I understand that if the position I am applying for requires the operation of eitheremployee or employer-owned motor vehicles I must maintain personal licensure

appropriate to vehicle and responsibilities of the position. Further, I authorize the

employer to request and obtain Drivers License Records necessary to confirm my

licensure and responsible driving history.

4) I understand that if offered employment, the offer may be contingent on my passing apre-employment substance-abuse screen, a pre-employment medical/healthexamination, and a psychological examination. I voluntarily agree to submit to a pre-employment substance abuse screen and/or medical/health examination on request. Iunderstand that failure to pass required substance abuse screens or medical/healthexamination may result in withdrawal of offer.

I have read, understand, and agree to, the above statements.

Signed: __________________________________ Date: ____________


7

TENNESSEN WARNING

In accordance with the Minnesota Government Data Practices Act, the City of Morris is required toinform you of your rights as they relate to the private information collected from you. Private data is

information that is available to you, but not the public. The personal information we collect about you is

private. Minnesota Statutes 13.04 and 13.43 are two sections that govern what affects you as an applicant

for employment with the City of Morris. All data collected is considered private except for the following:

(1) Your veteran’s status.

(2) Relevant test scores.

(3) Your rank on our eligibility list.

(4) Your job history.

(5) Your education and training.

(6) Your work availability.

Your name is considered private information; however, if you are selected to be interviewed as a finalist,

your name becomes public information.

The data supplied by you may be used for such other purposes as may be determined to be necessary in

the administration of personnel policies, rules, and regulations of the City of Morris. Furnishing socialsecurity numbers, date of birth (unless a minimum age is required), sex, age group, and disability data is

voluntary, but refusal to supply other requested information will mean that your application for

employment may not be considered.

Private data is available only to you, appropriate City employees, and others as provided by state and

federal law who have a bona fide need for the data. Public data is available to anyone requesting it and

consists of all data furnished in the application for employment that is not designated in this notice as

private data.

Except for race, sex, age, and disability data, the information you give us about yourself is needed to

identify you and to assist the City of Morris’s Administrator’s Office in determining your suitability forthe position for which you are applying. Race, sex, age, and disability data are used in summary form by

the City of Morris to monitor protected class employment and to meet federal, state, and local reportingrequirements.

I declare that I have read and understand the information given above regarding the Minnesota Data

Practices Act.

Applicant’s Printed Name: _____________________________________________________

Applicant’s Signature: _______________________________________ Date: ___________


8

VETERAN’S PREFERENCE CLAIMS FORM

The City of Morris operates under a point preference system which awards points to qualified veterans tosupplement their examination results. Five (5) preference points are granted for non-disabled veterans on open

competitive examinations. Ten (10) points are added if the veteran has a permanent service-connected, compensable

disability as certified as Veterans Administration.

To qualify for preference, you must have served on active duty in any branch of the Armed Forces of the United

States for 181 consecutive days or more, and have been honorably discharged; you must be a citizen of the United

States and currently not receiving a monthly veteran’s pension based exclusively on length of service. Veteran’s

Preference may be used by the surviving spouse of a deceased veteran and by the spouse of a disabled veteran who

because of the disability is unable to qualify.

Claims must be made on the form below. You must also submit a COPY of your DD214 or other military

documents to substantiate the service information requested on the form. Claims not accompanied by proper

documentation will not be processed and will result in disqualification.

NAME: ________________________________________________ Last First Middle

ADDRESS: ___________________________________________________________________________________ Street City State Zip

SOCIAL SECURITY #: ____________________________

Do you have a legal right to work in the United States? Yes No ACTIVE DUTY INFORMATION: (NOTE: Your DD214 form MUST accompany this claim form) Have you or

your disabled or deceased spouse served on active military duty without interruption for 181 days or more?

Yes No

Type of Separation: Honorable Medical Other

Are you receiving or are you eligible to receive a monthly veteran’s pension based exclusively on length of military

service? Yes No

FOR DISABLED VETERANS:

Percent of Disability: _________% Letter from V.A. in proof of disability must be submitted to receive points

Permanent? Yes No

Currently Existing? Yes No

Have you ever been promoted in City Employment? Yes No

Veteran’s Present Occupation: ____________________________________________________________________

FOR SPOUSES OF DECEASED VETERANS:

Date of Death: ___________________ Have you remarried? Yes No

AFFIDAVIT: I hereby claim veteran’s preference for this examination and certify that all information given is true,

complete and correct to the best of my knowledge.

Signature: ___________________________________________________ Date: __________________________


Supplemental Application Form

Applicant Name: ______________________________________________________________________

1

POLICE OFFICER1. Police Related Skills: Please check all the boxes below that relate to your police related

experience in the following areas and any other relevant information related to your experience:

Patrol Experience

Investigator Experience

K-9, School Resource Officer

Use of Force Instructor, Defensive Tactics, or Taser

Military Police, Corrections, Park Ranger, or Security Guard

Other:

Please describe your experience and how much experience you have on the items checked above:

2. Knowledge of Policing: Please check all the boxes below related to what experiences you have

had that has provided you with some additional insight on policing beyond the required education

and training.

Work or have worked in a police related field

Completed a ride-along with a law enforcement agency, Citizen Police Academy, Explorer,

Internship, or Reserve Officer Program

Law enforcement or skills instructor/professor references

Other:

Please describe your knowledge of policing and the experiences you have in detail:

YOU MUST COMPLETE AND RETURN THIS FORM TO BE CONSIDERED AS AN APPLICANT.

Please note: This supplemental form will be used to rank applicants, so please be complete and accurate in your

responses. Please attach additional sheets if needed to complete the responses below.

2

3. Leadership Skills: Please check all the boxes below that relate to your leadership skills. These

can include work, education, or personal experiences where the following have been

demonstrated.

Leadership position where elected or appointed by a group of peers as a squad or team leader

Assigned or appointed a position where you were the leader on an assignment or a project

Volunteered for a committee or organization where you were the leader or played a lead role

Other:

Please describe your skills in more detail including your experiences, positions, duration, etc:

4. Communication Skills: Please check all the boxes below related to your communication skills.

These can include work, education, or personal experiences where the following have been

demonstrated.

Speaking in front of large groups of people

Communicating difficult information to others

Speaking a foreign language, what language(s): how fluent?

Written communication (letters, reports, papers, etc.)

Other:

Please describe your skills in more detail including your experiences, skill level, and proficiency:

5. Customer Service Skills: Please check the boxes below related to your customer service

experience. These can include work, education, or personal experiences where the following

have been demonstrated.

Assisting customers one-on-one

Resolving customer complaints or issues

Experience handling difficult customer service issues

Other:

3

Please describe your skills in more detail including your experiences, skill level, and proficiency:

6. Community Service Skills: Please check the boxes below related to your experience as it

relates to community service.

Assisted people in need

Active member in my community on committees or organizations

Actively involved in a volunteer organization

Volunteer occasionally for organization in need

Other:

Please describe the experience and equipment used, the company, and duration:

*************

I hereby certify that all answers contained in this application are true and I agree and understand that any

misrepresentation or omission of facts contained in my application for employment or this addendum will be

grounds for disqualification for employment, or in the event of employment, immediate dismissal from

employment upon later discovery of any omission of facts or misrepresentations.

I further understand that if offered a position, I must submit to and pass a controlled substance screen and

will be required to submit to and pass a criminal background check, and employment reference checks.

By my signature on this form, I hereby acknowledge that I have read and understood the above

statements. Failure to sign application forms may result in rejection of your application.

Applicant’s signature: _______________________________________________

Date: _____________________________________


Morris Police Officer Qualification Questionnaire

1. The following supplemental information may be used as a scored evaluation of your knowledge,

skills and experience. Be certain that the choices you make correspond to the information you

have provided in your application and resume. You must be honest and accurate in answering

the supplemental questions and do not type “see resume”. You may also be asked to

demonstrate your knowledge and skills in a work sample, or during an interview for this position.By completing this questionnaire, you are attesting that the information you have provided istrue and accurate. Information provided may be reviewed by the hiring manager. Any

misstatements or falsification of information will eliminate you from consideration or may result

in dismissal. Do you understand and agree with this statement?

Yes

No

2. Have you ever been denied employment in a law enforcement related position based on the

findings of a background investigation?

Yes

No

3. MN STAT 626.87 and MN RULES 6700.0700 preclude certain individuals from licensure if

convicted of any felony as an adult. Have you been convicted of a felony since you became 18

years old?

Yes

No

4. MN STAT 626.87 and MN RULES 6700.0700 precludes certain individuals from licensure if

convicted for any of the following crimes. Please indicate if you have been convicted of any of the

following. (Select all that apply).

609.224 Assault in the fifth degree

609.2242 Domestic Assault

609.231 Mistreatment of residents or patients

609.2325 Criminal Abuse (vulnerable adult)

609.233 Criminal Neglect (vulnerable adult)

609.2335 Financial Exploitation (vulnerable adult)

Not Applicable

5. Have you been convicted under any state or federal narcotics or controlled substance law

irrespective of any proceeding under MN STAT 152.18, or any similar law of another state or

federal law?

Yes

No

6. If you indicated in any of the preceding questions that you have received a conviction or

convictions, please indicate the nature, date and location of the offense or offenses, the

disposition, as well as the terms of any probation requirements that you are under or have

successfully completed. If you have not received a conviction or convictions, type “N/A”. Note: if

offered this position, you will be subject to a thorough background pursuant to MN STAT 626.87

and MN RULES 6700.0700.

7. Which of the following best describes your experience as a fulltime sworn law enforcement

officer?

Less than 1 year

More than 1 year, but less than 55 years+

N/A – I do not have any employment experience as a fulltime sworn law enforcement officer

8. Which of the following best describes your active duty military police experience?Less than 1 year


N/A – I do not have any employment experience as military police

9. Which of the following best describes your active duty military experience, other than military

police experience?

Less than 1 year


N/A – I do not have any active duty military experience

10. Which of the following best describes your public contact/face to face customer service related

experience, other than police experience?

Less than 1 year


N/A – I do not have any public contact/customer service experience

11. Which of the following best describes your public safety related experience in corrections, park

ranger, security guard or working in a locked facility?

Less than 1 year

More than 1 year, but less than 55 years

N/A – I do not have any public safety related experience as described above

12. Have you had an internship in the public safety field?

Yes With who? No

Signature Date


MORRIS POLICE DEPARTMENT

Answer the following questions in your own words.

1. What do you perceive the duties of a police officer to be in today’s society?

2. Do you believe that a police officer’s off duty behavior effects his/her ability toperform his/her duties? Does the size of the community where the officer works effect your position on this matter?

3. What circumstances would you consider in not issuing a traffic citation?

4. What areas of police work interest you the most and how would you prepare yourself to achieve these goals?

Take the following facts and write an incident report using the form on the next page. Fill out the form to the best of your ability with the information presented; then write a brief report about the incident. Some information may not be provided. You are requested to fill in the information you deem pertinent for a complete report.

a) You are dispatched on March 6, 2021 at 0900.b) You respond to 510 Atlantic Avenue in Morris after dispatch informs you a woman called

reporting a theft.c) You speak to Jane Ann Doe (DOB 01/02/1981) at that address.d) Doe informs you she had property stolen from her vehicle during the night. e) The property stolen was a computer laptop.f) The computer is described as a HP Touch Intel. g) Doe purchased this laptop approximately two months ago and paid approximately $500.

Initial Report:

FILLABLE APP.pdfEmployment Application.pdfEmployment Application-Supplemental Pages PD.pdfEmployment Application.pdfUntitledUntitled

Employment Application-Supplemental Pages PD.pdfEmployment Application-Supplemental Pages PD.pdfPolice Officer Supplemental Questionnaire 2017

Police Officer Supplemental.pdf

QUESTIONNAIREQuestionsQuestions 2019OFFENSE PLACE OF OCCURRENCECOMPLAINANT ADDRESS AND PHONEDATE AND TIME REPORTED HOW REPORTEDOFFICER ASSIGNED DATE AND TIME COMMITTEDPROPERTY DESCRIPTION VALUE

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Position Applied For: Part Time: OffFull Time: OffSeasonal: OffDate of Application: Date Available for Work: Email Address: Last Name: First Name: Middle Name: Street Address: City: State: Zip: County: Phone Number: Have you been previously employed by the city: OffDate Employed by City: Position: Are you able to legally work in the US?: OffP: O: S: T Licensing: Off

License #: Expiration Date: Test Date: High School Name City State: Diploma: OffCollege1 Name City State: GED: OffOther: College1 Major Area of Study: College1 Degree Completed: OffCollege2 Name City State: College2 Degree Completed: OffOther_2: College2 Major Area of Study: Tech Name City State: Certificate Earned: Tech Major Area of Study: Employer: From: To: Job Title: Address: Telephone: Starting Rate: Ending Rate: Reason For Leaving: May we contact this employer?: OffNo If no Explain: Job Duties: Employer_2: From_2: To_2: Job Title_2: Address_2: Telephone_2: Starting Rate_2: Ending Rate_2: Reason For Leaving_2: No If no Explain_2: May we contact this employer?2: OffJob Duties_2: Employer_3: From_3: To_3: Job Title_3: Address_3: Telephone_3: Starting Rate_3: Ending Rate_3: Reason For Leaving_3: No If no Explain_3: May we contact this employer?3: OffJob Duties_3: Employer_4: From_4: To_4: Job Title_4: Address_4: Telephone_4: Starting Rate_4: Ending Rate_4: Reason For Leaving_4: No If no Explain_4: May we contact this employer?4: OffJob Duties_4: Employer_5: From_5: To_5: Job Title_5: Address_5: Telephone_5: Starting Rate_5: Ending Rate_5: Reason For Leaving_5: No If no Explain_5: May we contact this employer?5: OffJob Duties_5: Employer_6: From_6: To_6: Job Title_6: Address_6: Telephone_6: Starting Rate_6: Ending Rate_6: Reason For Leaving_6: No If no Explain_6: May we contact this employer?6: OffJob Duties_6: Explain periods of unemployment: OrganizationRow1: DutiesRow1: of HoursRow1: FromRow1: ToRow1: OrganizationRow2: DutiesRow2: of HoursRow2: FromRow2: ToRow2: OrganizationRow3: DutiesRow3: of HoursRow3: FromRow3: ToRow3: OrganizationRow4: DutiesRow4: of HoursRow4: FromRow4: ToRow4: Describe any additional experience or training that qualifies you for this job 1: Describe any additional experience or training that qualifies you for this job 2: Describe any additional experience or training that qualifies you for this job 3: Describe any additional experience or training that qualifies you for this job 4: Signature: Date2: Name OccupationRow1: AddressRow1: Phone NumberRow1: Name OccupationRow2: AddressRow2: Phone NumberRow2: Name OccupationRow3: AddressRow3: Phone NumberRow3: Name OccupationRow4: AddressRow4: Phone NumberRow4: Signature2: Date3: Applicants Printed Name: Signature3: Date_3: Last: First: Middle: Street-Veterans: City-Veterans: State-Veterans: Zip-Veterans: SOCIAL SECURITY: Group12: 2Group13: OffGroup14: OffGroup15: OffPercent of Disability: Group16: 2Group17: 2Group18: OffVeterans Present Occupation: Date of Death: Group19: 2Signature4: Date_2: Applicant Name20: Patrol Experience: 0: Off

Investigator Experience: OffK-9, School Resource Officer: OffUse of Force Instructor, Defensive Tactics, or Taser: OffMilitary Police, Corrections, Park Ranger, or Security Guard: OffOther Police Related Skills: OffOther Pulice Related Skills: Please describe your experience and how much experience you have on the items checked above 1: Please describe your experience and how much experience you have on the items checked above 2: Please describe your experience and how much experience you have on the items checked above 3: Please describe your experience and how much experience you have on the items checked above 4: Work or have worked in a police related field: 0: Off

Completed a ride-along w/law enforcmt agency, Citizen Police Academy, Explorer, Internship or Reserve Officer Program: OffLaw enforcement or skills instructor/professor references: OffHave Other Knowledge of Policing: OffOther Knowledge of Policing: Please describe your knowledge of policing and the experiences you have in detail 1: Please describe your knowledge of policing and the experiences you have in detail 2: Please describe your knowledge of policing and the experiences you have in detail 3: Please describe your knowledge of policing and the experiences you have in detail 4: Other Leadership Skills: Please describe your skills in more detail including your experiences positions duration etc 1: Please describe your skills in more detail including your experiences positions duration etc 2: Please describe your skills in more detail including your experiences positions duration etc 3: Please describe your skills in more detail including your experiences positions duration etc 4: Communication Skills 1: 0: Off1: Off2: Off3: Off4: Off

Foreign Language: Fluentcy?: Other Communication Skills: Please describe your skills in more detail including your experiences skill level and proficiency 1: Please describe your skills in more detail including your experiences skill level and proficiency 2: Please describe your skills in more detail including your experiences skill level and proficiency 3: Please describe your skills in more detail including your experiences skill level and proficiency 4: Customer Service Skills 1: 0: Off1: Off2: Off3: Off

Other customer service skills: Please describe your skills in more detail including your experiences skill level and proficiency 1_2: Please describe your skills in more detail including your experiences skill level and proficiency 2_2: Please describe your skills in more detail including your experiences skill level and proficiency 3_2: Please describe your skills in more detail including your experiences skill level and proficiency 4 2: Community Svc Skills 1: 0: Off1: Off2: Off3: Off4: Off

Other Community Service Skills: Please describe the experience and equipment used the company and duration 1: Please describe the experience and equipment used the company and duration 2: Please describe the experience and equipment used the company and duration 3: Please describe the experience and equipment used the company and duration 4: Applicant's Signature20: Date20: Do you understand and agree: Choice4Denied employment due to backgrd investigation: OffHave you been convicted of felony since 18 years of age?: OffConviction1: OffConviction2: OffConviction3: OffConviction4: OffConviction5: OffConviction6: OffConviction N/A: OffNarcotics or Controlled substance conviction?: OffDetails of any Convictions or N/A: FT Law Enforcement Officer Experience: No ExperienceActive Duty Military Police Experience: OffActive Duty Military Experience: OffCustomer Svc Experience: OffPublic Safety Related Experience: OffInternship in Public Safety Field: OffSignature - Electronic: Date: Text3_es_: Text1: Text2: Text3: Text4: Text5: Leadership Skills1: 3: Off2: Off1: Off0: Off

morris police department 400 colorado avenue p.o. box 245 … · 2020. 12. 11. · the city of...

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