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Town of NEWTOWN
APPLICATION FOR EMPLOYMENT – POLICE DEPARTMENT Newtown Police Department, 3 Main Street, Newtown, CT 06470
“We are equal opportunity employers. We are dedicated to a policy of nondiscrimination in employment on any basis including race, creed, color, age, sex, religion, national origin, or physical defects”.
Date of Application ______________
NAME: __________________________________________________________________________________
Last First Middle
ADDRESS:_______________________________________________________________________________
PHONE #:__________________ EMAIL: _______________________ SOC. SEC. #: ________________
Referred by:______________________________________________________________________________
EMPLOYMENT: Position Desired________________________Permanent: Temporary FT PT
Date Available:____________Are you employed now?_______ May we contact your present employer?______
Have you applied to either Town before?________ When? ________________ Town? __________________
EDUCATION:
Circle # of years completed |
Name & Location of School |
Years Attended |
Date Graduated |
Subjects Studied/ Degree Awarded |
High School: 0 1 2 3 4 GED |
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College: 1 2 3 4 |
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College: 5 6 7 8 |
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Trade, Business or Correspondence School |
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Technical/Professional Licenses: Type:_______________________ Number:_______________ State:_____
Date:______________ Current?______________
Internships: Type:____________ Company/Facility Name:___________________________ Dates:________
Special Study/Skills:________________________________________________________________________
EMPLOYMENT HISTORY: List and describe your work experience. Begin with most recent position first. Include title changes when applicable.
Dates Month/Year |
Name & Address of Employer |
Position Title |
Final Salary
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Reason for leaving |
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Volunteer Experience: ______________________________________________________________________
Professional Affiliations:____________________________________________________________________
U.S. Military Service: _______ Rank: ________________ Presently in National Guard or Reserves? ________
· Are You a Citizen of the United States? YES NO
· Do you possess a valid motor vehicle operator’s license? YES NO
LIC. # __________________ ST ____
· Are you 21 years of age or older? YES NO
· Are you a Certified Connecticut Police Officer? YES NO
o Cert. # ______________ Cert. Date ___/___/___ Exp. Date ___/___/___
· Have you been arrested or convicted of a Felony Crime? YES NO Details:_____________________________________________________________________________
· Have you been arrested or convicted of a Class “A” or “B” Misdemeanor Crime? YES NO
Details:_____________________________________________________________________________
· Have you ever committed an act of perjury or making a false statement? YES NO Details:_____________________________________________________________________________
I authorize investigation of all statements contained in this application. I understand that misrepresentation or misstatements of facts is cause for dismissal.. Further, I understand and agree that my employment is for no definite period and may regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice.
Date:________________ Signature: __________________________________________________________
Date Received: ____________
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