Online Application

PHOTOGRAPH OF YOURSELF TAKEN WITHIN THE LAST SIX MONTHS (HEAD AND SHOULDERS ONLY) *

Max file size: 20MB

COPY OF DRIVERS LICENSE *

Max file size: 20MB

COPY OF BIRTH CERTIFICATE *

Max file size: 20MB

COPY OF DD214 (IF VETERAN) *

Max file size: 20MB

COPY OF HIGH SCHOOL TRANSCRIPT / GED CERTIFICATE (TRANSCRIPTS, NOT DIPLOMA) *

Max file size: 20MB

COLLEGE TRANSCRIPTS (IF APPLICABLE) *

Max file size: 20MB

ADDITIONAL TRANSCRIPTS (IF APPLICABLE) *

Max file size: 20MB

PART 1 - PERSONAL INFORMATION

LIST ALL DEPENDENTS BELOW (2 MINIMUM)

PART 2 - EDUCATION

All transcripts from schools attended must be uploaded in order to prove status with the institution. These transcripts will become the property of the Bedford Police Department. Failure to do so could terminate further consideration for employment.

Foreign Language: Enter foreign language then then indicate your knowledge of each by checking the proper box:

PART 3 - MILITARY HISTORY AND STATUS

PART 4 - SPECIALIZED TRAINING

PART 5 - EMPLOYMENT RECORD

1. COMPANY NAME: *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

TYPE OF BUSINESS *

DATES EMPLOYED *

TITLE HELD/WORK DESCRIPTION *

WEEKLY SALARY *

NAME OF SUPERVISOR *

REASON FOR LEAVING *

MAY WE CONTACT THIS EMPLOYER? *

YES NO

2. COMPANY NAME: *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

TYPE OF BUSINESS *

DATES EMPLOYED *

TITLE HELD/WORK DESCRIPTION *

WEEKLY SALARY *

NAME OF SUPERVISOR *

REASON FOR LEAVING *

MAY WE CONTACT THIS EMPLOYER? *

YES NO

3. COMPANY NAME *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

TYPE OF BUSINESS *

DATES EMPLOYED *

TITLE HELD AND WORK DESCRIPTION *

WEEKLY SALARY *

NAME OF SUPERVISOR *

REASON FOR LEAVING *

MAY WE CONTACT THIS EMPLOYER? *

YES NO

4. COMPANY NAME *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

TYPE OF BUSINESS *

DATES EMPLOYED *

TITLE HELD AND WORK DESCRIPTION *

WEEKLY SALARY *

NAME OF SUPERVISOR *

REASON FOR LEAVING *

MAY WE CONTACT THIS EMPLOYER? *

YES NO

PART 6 - PERSONAL REFERENCES

Please list the names of three references that are not past employers or relatives. These people may be called on to answer questions about your personal background.

1. Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

OCCUPATION *

Phone Number *

YEARS KNOWN *

UPON WHICH OF THE FOLLOWING CONDITIONS IS YOUR ACQUAINTANCE WITH THIS PERSON BASED *

SOCIAL BUSINESS EDUCATION NEIGHBOR

2. Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

OCCUPATION *

Phone Number *

YEARS KNOWN *

UPON WHICH OF THE FOLLOWING CONDITIONS IS YOUR ACQUAINTANCE WITH THIS PERSON BASED *

SOCIAL BUSINESS EDUCATION NEIGHBOR

PART 7 - CRIMINAL HISTORY

DO YOU HAVE A VALID INDIANA DRIVERS LICENSE? * *

YES NO

DRIVER LICENSE NUMBER *

HAVE YOU RECEIVED ANY TRAFFIC CITATIONS SINCE YOUR 18TH BIRTHDAY? *

YES NO

IF YES, PROVIDE DATE / AGENCY / CHARGE / DISPOSITION FOR EACH CITATION: *

LIST ALL TRAFFIC ACCIDENTS YOU HAVE BEEN INVOLVED IN AS A DRIVER SINCE YOUR 18TH BIRTHDAY (DATE, AGENCY, LOCATION, AT FAULT (YES OR NO), COMMENTS) *

HAS YOUR DRIVERS LICENSE EVER BEEN SUSPENDED, REVOKED, OR RESTRICTED? *

YES NO

IF YES, GIVE DETAILS *

LIST ALL STATES THAT YOU HAVE EVER HELD A LICENSE WITH. INCLUDE MILITARY LICENSES *

PART 8 - MISCELLANEOUS

DO YOU OWN YOUR HOME? *

YES NO

IF YES, AMOUNT OF CURRENT MORTGAGE INDEBTEDNESS *

WHAT IS THE AMOUNT OF YOUR INDEBTEDNESS, OTHER THAN HOME? *

HAVE YOU EVER APPLIED FOR A PERMIT TO CARRY A HANDGUN? *

YES NO

REASON *

STATUS *

WHAT SPECIAL SKILLS HAVE YOU DEVELOPED THROUGH HOBBIES, EDUCATION, OCCUPATION, OR OTHER SPECIAL INTERESTS? *

ARE YOU A PROPRIETOR OR PART-OWNER OF ANY BUSINESS OR FIRM? *

YES NO

IF YES, PLEASE EXPLAIN (NATURE OF BUSINESS OR FIRM, ANY LICENSES FOR THIS/THESE BUSINESS(ES) IN YOUR NAME; I.E. LIQUOR LICENSE) *

Part 9 - Why do you want to be an Officer at the Bedford Police Department

Authorization

I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION (AND ACCOMPANYING RESUME) ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT ANY FALSE STATEMENT, OMISSION, OR MISREPRESENTATION ON THIS APPLICATION IS SUFFICIENT CAUSE FOR REFUSAL TO HIRE, OR DISMISSAL IF I HAVE BEEN EMPLOYED, NO MATTER WHEN DISCOVERED BY THE COMPANY. I UNDERSTAND THAT MY EMPLOYMENT IS CONDITIONED ON A COMPLETE BACKGROUND CHECK. I HEREBY AUTHORIZE THE CITY OF BEDFORD TO THOROUGHLY INVESTIGATE ALL STATEMENTS CONTAINED IN MY APPLICATION OR RESUME, AND I AUTHORIZE MY FORMER EMPLOYERS AND REFERENCES TO DISCLOSE INFORMATION REGARDING MY FORMER EMPLOYMENT, CHARACTER, AND GENERAL REPUTATION TO THE CITY OF BEDFORD, WITHOUT GIVING ME PRIOR NOTICE OF SUCH DISCLOSURE. I RELEASE THE CITY, ANY FORMER EMPLOYERS, AND ALL REFERENCES LISTED ABOVE FROM ANY AND ALL CLAIMS, DEMANDS, OR LIABILITIES ARISING OUT OF OR RELATED TO SUCH INVESTIGATION OR DISCLOSURE. I UNDERSTAND AND AGREE THAT NOTHING CONTAINED IN THIS APPLICATION, OR CONVEYED DURING ANY INTERVIEW, IS INTENDED TO CREATE AN EMPLOYMENT CONTACT. I FURTHER UNDERSTAND AND AGREE THAT IF I AM HIRED, MY EMPLOYMENT WILL BE “AT WILL” AND WITHOUT FIXED TERM, AND MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITHOUT PRIOR NOTICE, AT THE OPTION OF EITHER MYSELF OR THE CITY OF BEDFORD. NO PROMISES REGARDING EMPLOYMENT HAVE BEEN MADE TO ME, AND I UNDERSTAND THAT NO SUCH PROMISE OR GUARANTEE IS BINDING UPON THE CITY UNLESS MADE IN WRITING. IF I AM OFFERED EMPLOYMENT, I AGREE TO SUBMIT TO A MEDICAL EXAMINATION AND DRUG TEST BEFORE STARTING WORK. IF EMPLOYED, I ALSO AGREE TO SUBMIT TO A MEDICAL EXAMINATION OR DRUG TEST AT ANY TIME DEEMED APPROPRIATE BY THE CITY OF BEDFORD AND AS PERMITTED BY LAW. I CONSENT TO SUCH EXAMINATIONS AND TESTS, AND I REQUEST THAT THE EXAMINING DOCTOR DISCLOSE THE CITY THE RESULTS OF THE EXAMINATION, WHICH RESULTS SHALL REMAIN CONFIDENTIAL AND SEGREGATED FROM MY PERSONNEL FILE. I UNDERSTAND THAT MY EMPLOYMENT OR CONTINUED EMPLOYMENT, TO THE EXTENT PERMITTED BY LAW, IS CONTINGENT UPON SATISFACTORY MEDICAL EXAMINATIONS AND DRUG TESTS, AND IF I AM HIRED A CONDITION OF MY EMPLOYMENT WILL BE THAT I ABIDE BY THE CITY’S DRUG AND ALCOHOL POLICY. I UNDERSTAND THAT FILLING OUT THIS FORM DOES NOT INDICATE THERE IS A POSITION OPEN AND DOES NOT OBLIGATE THE CITY OF BEDFORD TO HIRE. IF HIRED, I AGREE TO ABIDE BY ALL COMPANY RULES, POLICIES AND PROCEDURES, IN WHOLE OR IN PART, AT ANY TIME. *

Employment