Patrol Officer Application

Application No

Date Received

Time Received

Social Security Number

Phone No

General Instructions:

This application consists of several sections: 1) Questionnaire; 2) Notification of Procedure Release; 3) Verification of Statements; 4) Waiver & Background release; and 5) Essential Job Functions for a Police Officer. Every one of these sections must be completed in order for the Borough of Oakmont to accept the application as complete. Print (do not type) an answer to every question. If a particular question does not apply to you, so state with “N/A”. If space available is insufficient, use additional paper and mark your information with the number of the item you are answering. DO NOT mis-state or omit material fact since the statements made herein are subject to verification to determine your qualifications for employment.

Part-Time Police Officer

The Borough of Oakmont is accepting applications for part-time police officer. Applications may be picked up at the Oakmont Borough Building 767 Fifth St Oakmont, Pa 15139 or on-line at oakmontborough.com under the services tab, forms and permits. Applicants will need to be at least 21 years of age, be Act 120 certified, pass a physical and psychological examination as well as a background and driving record check. The starting salary is determined by current Collective Bargaining Agreement (CBA). Uniforms provided. Body Armor reimbursement after six months of service. Oakmont is an equal opportunity employer.

Questionnaire

Last Name

First Name

Middle

Alias(es), Nickname(s), Maiden Name, or Name Change

Address

Street Address City State / Province / Region ZIP / Postal Code

Date of Birth

Native United States Citizen?

Yes

No

If "No," List Naturalization Number/Date/Place:

Residences

List all for the past ten (10) years beginning with the most current.

Month & Year From:

Month & Year To:

Address

With Whom Did You Live/Where Are They Now?

Family:

List in order given showing relationship, parents, guardians, step-parents, foster parents, parents-in- law, brothers, sisters, step-brothers and step-sisters. Include any others with whom you have resided or with whom a close relationship existed or exists.

Relationship

Name

Address, if Living

Are you reated to any Borough employee?

Yes

No

If yes, who?

Vehicle Operator’s License:

Give the following information concerning any vehicle operator’s license(s) you have held, or now hold:

Type of License

Number

Issuing Authority

Expiration Date

Have you ever had a license suspended or revoked

Yes

No

If “Yes,” please explain

Conviction of Crime

Have you ever been convicted of a misdemeanor, felony or greater criminal violation?

Yes

No

If "Yes," state violation, court of jurisdiction, and date of conviction:

Financial Status:

Do you have any income from any source other than your principal occupation?

Yes

No

How Much?

How often?

Do you have, or have you had, any financial account (savings, checking, loans, stocks, bonds, etc.)?

Yes

No

List all accounts during the past seven (7) years.

Name and Address of Financial Institution

Type of Account

Past and Present Membership in Organizations:

Name, Address, Zip

Organization Type

Office Held, If Any

Membership Dates (to)

Membership Dates (from)

Subversive Organization

Are you now, or have you ever been affiliated with any group whose policies or activities are subversive to the form of government set forth in the Constitutions and laws of the Unites States and Pennsylvania?

Yes

No

If "Yes," describe the circumstance, specify the nature and extent of association with each, including office or position held. Also, include dates, places and credentials now or formerly held.

Education

List all elementary, junior high and high schools attended. (Attach transcript from last High School attended. If not applicable, provide a copy of GED.)

Name, Address, City, Zip

Dates Attended (from):

Dates Attended (to):

Years Completed

Graduated (yes/no)

Post-Secondary Education. List all colleges or universities attended. (Attach transcript from last institution.)

Name, Address, City, Zip

Dates Attended (from):

Dates Attended (to):

Years Completed

Graduated (yes/no)

Other Schools or Training (trade, vocational, military). Give for each the name and location of school:

Name, Address, City, Zip

Dates Attended (from):

Dates Attended (to):

Subjects Studied

Certificate Earned

Any Other Pertinent Information with regard to Education History:

Special Qualifications and Skills:

Indicate type of special license such as pilot, radio operator, etc., show licensing authority, where the license was first issued, and date current license expires:

Special skills you possess and machines and equipment you can use. (For example: computer Programmer; polygraph operator, vehicle inspection mechanic, scientific or professional devices)

Knowledge of General Office Skills:

Keyboard or Typewriter

Yes

No

If yes WPM

Basic Office Equipment

(Copiers, Fax Machine, Scanner, etc.)

Yes

No

Special qualifications not covered in application. (For example, your most important publications, patents, inventions, public speaking, membership in professional or scientific societies, honors and fellowships received, etc.):

Foreign Language

Enter language and indicate level of fluency:

Language

Reading

Speaking

Understanding

Writing

Employment

Begin with your most recent job and list your work history for the past 10 years, including part-time, temporary or seasonal employment, and all periods of unemployment:

Dates of Employment (To)

Dates of Employment (From)

Name of Employer

Address

Street Address City State / Province / Region ZIP / Postal Code

Job Title

Reason for Leaving

Description of Duties:

Salary

Name of Supervisor

Name of Co-Worker

Add Additional Employment History

Yes

No

Dates of Employment (To)

Dates of Employment (From)

Name of Employer

Address

Street Address City State / Province / Region ZIP / Postal Code

Job Title

Reason for Leaving

Description of Duties:

Salary

Name of Supervisor

Name of Co-Worker

Add Additional Employment History

Yes

No

Dates of Employment (To)

Dates of Employment (From)

Name of Employer

Address

Street Address City State / Province / Region ZIP / Postal Code

Job Title

Reason for Leaving

Description of Duties:

Salary

Name of Supervisor

Name of Co-Worker

Have you ever been discharged, terminated, asked to resign, furloughed, or put on inactive status for cause, or subject to disciplinary action while in any position (except military)?

Yes

No

If "Yes" state reason:

Have you ever resigned after being informed your employer intended to discharge you for any reason?

Yes

No

If "Yes," explain, giving name and address of employer, approximate date, and reason in each case:

Military Status

Have you served in the U.S. Armed Forces? If “Yes,” attach a copy of your DD214.

Yes

No

Do you claim Veterans' Preference? If “Yes,” attach a copy of your DD214.

Yes

No

While in the military service were you ever convicted for any crime graded as a misdemeanor, felony or greater offense? If “Yes,“ provide date, place, law enforcing authority or type of court or court martial, charge and action taken for each incident, using separate sheets to record this information

Yes

No

Selective Service:

Selective Service No

Last Classification

Date

Local Board

Address

Street Address City State / Province / Region ZIP / Postal Code

Character References

List only character references who have definite knowledge of your qualifications for the position of application. List three (3) character references. (Do not list relatives, former employers, or persons living outside the United States.)

References

Name

Address

Home Phone

Work Phone

Years Known

Have you ever applied for a position with any other governmental agencies?

Yes

No

If “Yes,” give details:

Upload Necessary Files

Accepted file types: pdf, jpg, png, doc, docx, Max. file size: 256 MB.

Notification of Procedure Release

In the processing procedure required for applicants, it may become necessary to contact the applicant in the event he/she is being given further consideration for the position of police officer with the Borough of Oakmont. If conventional methods fail in attempting to contact the applicant, a Certified, Registered Letter will be sent to the applicant address listed on the application. Should the Registered Letter be returned indicating that it was unclaimed or undeliverable, the applicant will be eliminated from further processing and consideration. It is the applicant’s responsibility to notify the Borough of Oakmont, in writing, of any address change. By affixing your signature to this form, the applicant acknowledges that he/she read and understood the contents of this procedure.

Signature of Applicant

Print Name

Date

Verification of Statements

I , verify that the statements made in the foregoing Patrol Officer Application for the Borough of Oakmont, Allegheny County, Pennsylvania are true and correct to the best of knowledge, information and belief. I understand that any false statements made herein are subject to the penalties of 18 PA. C. S. §4904, relating to unsworn falsification to authorities, and subject to the penalties set forth in the Borough of Oakmont Civil Service Rules and Regulations relating to false statements. (Article III, Section 3.1)

Signature of Applicant

Print Name

Date

Waiver and Release for Background Investigation

I, , hereby give the Borough of Oakmont the right to make a thorough investigation into my background, previous employment, education, credit status, and references in order to ascertain my suitability for service as a Borough of Oakmont police officer. I release from all liability and claims any and all persons, companies and corporations (public and private) supplying any information whatsoever to representatives of the Borough of Oakmont. This includes and is not limited to parties with whom I have entered into a written or oral agreement which contains a confidentiality clause. I release, indemnify and hold harmless the Borough of Oakmont, its officials, officers and employees from and against any and all liability which might result from conducting such an investigation.

Signature of Applicant

Print Name

Date

Notary Public

1. Running for several hundred yards.

2. Climbing over obstacles

3. Crawling

4. Pushing motor vehicles

5. Pulling or carrying accident, fire or crime victims

6. Using physical force to apprehend and subdue arrestees

7. Withstanding prolonged exposure, as long as eight (8) hours, to extreme weather conditions

8. Withstanding prolonged periods of standing and sitting

9. Withstanding frequent exposure to stress-producing situations such as encountering persons injured or killed by accidents, crimes, or suicide

10. Dealing with domestic disputes

11. Dealing with verbal and physical abuse of the officer, including taunts, insults, and threats to the officer, family members, or fellow police officers

12. Professionally and effectively communicate with citizens (including jeveniles), Borough personnel, and other law enforcement personnel and first responders

13. Operating a motor vehicle for long periods of time

14. Using a firearm effectively

15. Filling out written reports in a clear and concise manner

16. Rendering assistance with river rescue to potential drowning victim(s) through the use of swimming/basic water safety techniques

17. Maintain and display a thorough knowledge and application of enforcement of criminal statues, the Motor Vehicle Code, and Borough Ordinances, including revisions and relevant court decisions affecting same, as well as Department orders, policies, and procedures.

18. Maintain alertness using all of the sense, including sight, hearing, and smell to uphold the functions and goals of the Department

19. Must have the ability to solve practical problems, often under stress and/or within a limited time frame

20. Must have the ability to engage in physically and mentally demanding work under unusual or potentially hazardous conditions.

21. Maintains ACT 120 Certification

22. Must have the ability to withstand prolonged exposure to extreme weather conditions

23. Render assistance to river rescue to those in distress through the use of swimming and basic water safety techniques.

24. Maintain ability to withstand prolonged periods of standing, sitting, including sitting in a police vehicle.